Special Assistance

IMPORTANT INFORMATION

A separate request is required for each passenger in need of assistance

It is mandatory the Hays Travel Disability checklist is completed and attached prior to submitting the Special Assistance form

Checklist Link

If you cannot access the any of the links on this form, please contact Vista Aftersales on 0191 814 8001, Option 2

Booking Details

HTR Reference*

Lead Passenger*

Booking Date*

Departure Date*

Special Assistance Details

Which Passenger Requires Assistance*

A separate request is required for each passenger in need of assistance

Which Assistance is Required*

Please select all that apply

Select

Allergies and Dietary Requirements*

Please add specific details below.

Will Passenger Be Taking Medical Equipment?*

Select

Carriage of Medical Equipment or Medication*

Please select all that apply

Select

CPAP Machine Form Completed*

Please follow the below link and complete the CPAP Machine form. Once complete, please attach below.

CPAP Machine Link

Medication*

Please add specific details of medication. Please note letter from GP may be required - If the customer has already provided a letter, please attach below.

Will passenger be taking medication during flight?*

If Yes, please attach letter below from GP confirming this information

Select

Medical Equipment*

Please add specific details below.

Does the Medication Require Storage?*

If YES, please add specific storage details below.

Mobility Assistance*

Select

Wheelchair Form Completed and Attached*

Please follow the below link and complete the Mobility Assistance form. Once complete, please attach below.

Mobility Assistance Link

Mobility Scooter Form Completed and Attached*

Please follow the below link and complete the Mobility Assistance form. Once complete, please attach below.

Mobility Assistance Link

Other Walking Aid*

Please add specific details below. If Airport Assistance is required, please follow the below link and complete the Mobility Assistance form. Once completed, please attach below.

Mobility Assistance Link

Has an Adaptable Transfer been booked?*

If no, additional costs may apply and is subject to availability.

Select

Has an Accessible Room been booked?*

If no, additional costs may apply and is subject to availability.

Select

Has an Accessible Cabin been booked?*

If no, additional costs may apply and is subject to availability.

Select

Hidden Disability Assistance*

Please advise what hidden disability the customer has and detail what assistance is required

Please Attach Completed Forms and/or Medical Documentation Here*

Drag and drop files here or

Agent Contact Details

Agent Name*

Agent Telephone Number*

Agent Email Address*

Agent Comments

Send me a copy of my responses

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