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Special Needs Questionnaire

Guests who require special accommodations should fill out this form.

The questions below will help identify any special accommodations needed on a Cruise West cruise or tour as the result of a disability or medical condition. This information will assist us in providing the best service and safest environment possible. Our primary concern is the health, safety and well being of our guests and crew. Cruise West does not discriminate against persons on the basis of disability.

Due to the limitation of medical facilities, guests with serious medical conditions or women with pregnancy complications or in the third trimester of pregnancy should consult their physician to determine whether travel is appropriate. If you have any questions about the nature of the medical facilities on board, please contact our Reservations Department at 1-888-396-0280 or Karen Clark in Marine Operations at (206) 733-5635. Guests should also review their insurance policies to determine whether the cost of treatment occurring onboard the vessel or while traveling is covered.

Guests are advised that personal services and devices, such as wheelchairs or oxygen equipment will not be provided by Cruise West. Guests in need of services of a personal nature, such as assistance in eating, toileting, or dressing, are responsible for arranging for such services and are encouraged to travel with a companion for such purposes.

Email Address:*
Booking Number:
Vessel Name:
Tour Date:
Travel Agent:
Travel Agent Phone:
Guest Name:
Guest Phone:
Do you have any conditions where lack of immediate medical care other than routine first aid would impose a health risk to yourself?
Do you have any limitation that would affect your ability to understand oral instruction in an emergency?
Do you require the use of any of the following special equipment?
If so, please specify the type of equipment and provide the name and phone number of the company supplying the equipment for your cruise. The contact information is used by Cruise West to verify equipment delivery/retrieval information, and to arrange for special ground transportation if necessary.
Wheelchair:
If so, can you climb stairs to board a motorcoach?
Note: Guests requiring a wheelchair must provide their own collapsible wheelchair.
Electric-scooter:
Please provide approximate dimensions, turning radius, and weight.
Oxygen:
Please provide type of equipment (i.e., concentrator, E-tanks, etc.)
Other:
Please describe.
Name and phone number of equipment supplier:
Please indicate equipment you are requesting for your vessel cabin or hotel room:
Sharps container:
Elevated toilet seat:
Shower chair:
HIMP Hotel Kit:
Other:
Please describe.
Comments: