Mobility Questionnaire Each passenger in your party should complete and submit the following form Mobility Questionnaire Title, First Name & Surname * Email Address * Date of Travel Ship Today's Date * 1. Do you need assistance to walk 300ft/100m? * Yes No 2. Do you use a walking stick/cane? * Yes No 3. Do you use a walker or rollator? * Yes No 4. Do you use crutches? * Yes No 5. Do you need assistance when walking on uneven surfaces (cobbles/grass/sand)? * Yes No 6. Do you use a wheelchair? * Yes No 7. Do you need assistance to ASCEND 2 flights of stairs (24 steps):- * Yes No 8. Do you need assistance to DESCEND 2 flights of stairs (24 steps)? * Yes No 9. Do you need assistance to negotiate up to a 6 inch kerb without a mobility device? * Yes No 10. Do you need assistance to negotiate ramps greater than 12.5% grade without railings? * Yes No 11. Do you need assistance to get off the floor unassisted? * Yes No 12. Do you need assistance to enter/exit a tender boat? * Yes No 13. Do you require oxygen? * Yes No 14. Can you get up from sitting unassisted 100% of the time? * Yes No 15. How many times have you fallen in the last 12 months? * Please provide any further relevant information Please read the following text carefully. By completing this form, if I have answered YES to one or more of the questions numbered 1 to 13 I understand I may experience some difficulty on some aspects of my cruise/ports of call/shore excursions which have been explained to me/are shown below. Please note this list is not exhaustive and we are happy to answer any questions you may have. CroisiEurope River Douro, Portugal Cruises • There is a lift/elevator available to all decks except the sun deck • Wheelchair accessible shore excursions are not available. All excursions are via motorcoach with steps to entry (not low entry or “kneeling” coaches). Some excursions may involve considerable walking and others may be panoramic tours where viewing of places of interest takes place from the coach (or a mixture of both). The Reception desk onboard will be happy to advise you. • The places you visit on your port calls may not be suitable for wheelchairs and may have cobbles or uneven surfaces. • Access on and off the ship is via a ramp, the gradient of which will alter according to the water levels. • Occasionally, the ship may dock alongside another ship where access to the shore will be through another vessel. • The ship and access on and off the ship is not suitable for full time wheelchair users. • Part time wheelchair users can take a wheelchair onboard for use on shore, the wheelchair must be stored in your cabin. • All cabins have telephones so you can call Reception or the Dialysis Team if required. Celestyal Greek Island Cruises • There are lifts/elevators to all decks • Wheelchair accessible shore excursions are not available. All excursions are via motorcoach with steps to entry (not low entry or “kneeling” coaches) . Some excursions may involve considerable walking and others may be panoramic tours where viewing of places of interest takes place from the coach (or a mixture of both). The shore excursion desk onboard will be happy to advise you. • Please view the Celestyal shore excursion guides on our website for detailed information. • The places you visit on your port calls may not be suitable for wheelchairs and may have cobbles or uneven surfaces. • If you wish to explore independently, at your own pace, the reception staff onboard will be happy to arrange a taxi for you. • Access on and off the ship is via a ramp, the gradient of which will alter according to the tide levels. • Some ports are tender ports where you will be required to enter and exit a tender boat if you wish to go ashore. • Wheelchair accessible cabins for full time wheelchair users are available, subject to availability. • Part time wheelchair users can take a wheelchair onboard for use onboard and on shore, the wheelchair must be stored in your cabin. • All cabins have telephones so you can call Reception or the Dialysis Team if required. I confirm the answers to the above questions are an accurate description of my ability. If my answers to any of the above questions change between now and my cruise departure date I agree to advise Cruise Dialysis, in writing, immediately. Signature * reCAPTCHA If you are human, leave this field blank. Submit
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