Will a dialysis patient be occupying this cabin? If yes, please put the dialysis patient's details in the boxes for PASSENGER 1 below *

Is Passenger 1 a dialysis patient? *

Is Passenger 2 a dialysis patient? *

Cruise *

Cabin upgrades are usually chargeable however on some occasions, the cruise line may upgrade you on a complimentary basis. Please note that whilst this will be to a cabin of a higher grade, it may be located on a lower deck. It is important to note that some cabins have a bath with shower over therefore if you cannot climb into a bath we would advise you decline the complimentary upgrade. *

Once you have made your booking you can choose your evening dining time and table size. In the meantime please advise us if any of the guests have the following dietary requirements. *

Does the passenger taking the wheelchair / mobility scooter need to use the wheelchair onboard, ashore or both? *

Does the dialysis patient require assistance to get on and off the bed in the dialysis unit? *

Does the patient currently test negative for Hepatitis B, Hepatitis C, HIV and MRSA? *

Do any of the passengers have any sensory impairments? *

Do any of the passengers require supplementary oxygen? *

I am aware of the cost of the dialysis during my cruise *

I am aware of the cost of the service charge for my cruise *