Princess Mobility Questionnaire

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mobility questionnaire
Our records indicate you will be traveling with a mobility device on your upcoming sailing. Please take a moment to fill out the
below information so we can advise you further regarding appropriate arrangements for your cruise.
Booking information
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Title First name Middle name Last name Suffix
_________________________________________ _________________________________________________________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _________________________________________ _________________________________________ _____________________________________________________________ _____________________________________________________________

Sail date Ship name Stateroom Category Booking# Embarkation port Disembarkation port
Indicate what type of mobility device you will be traveling with on your cruise. Please select all that apply.
Indicate type of device Device dimensions

Mobility
device Collapsible
Standard Heavy Duty Weight Width Height Length
(Yes or No)
Manual
Wheelchair
Power Wheelchair
Scooter (3-wheel)
Scooter (4-wheel)
Walker / Rollator
Please indicate if the mobility device is a rental to be delivered to the ship Yes No
Please list any additional mobility equipment you will be bringing to travel with (e.g. hoist, portable commode, etc.)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
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Mobility devices with batteries must be a dry cell, gel, or lithium-ion type and must be stored and recharged in the stateroom.
Mobility devices of any kind, like other items, may not be left outside the stateroom. Please be sure that your mobility equipment
is no wider than 22” if booked in a standard cabin or no wider than 31” if booked in an accessible cabin.
Mobility Status
Please indicate the usage of your mobility device by selecting one of the below options.
Full-time use Frequent use Part- time use Distance use
Are you able to negotiate steps on and off of a motorcoach? Yes No
If you answered no to the above question and a lift equipped vehicle is required for transportation, please list combined weight of
passenger and device _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Are you able to transfer from your device to a seat? Yes No
Will you be traveling with a companion who is able to assist you? Yes No
Pre- and Post-cruise programs

If you are booked on a Cruisetour or pre or post cruise hotel stay (excluding Alaska Cruisetours), please let us know if you require an
accessible hotel room.
I require Accessible hotel room? Yes No
If you require specific features in your room please list them below.
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If you are booked on an Alaska Cruisetour, please inform us regarding your room requirements below.
I require a ground floor lodge room (if elevator not available)? Yes No
I require an accessible lodge room? Yes No
Other _________________________________________________________________________________________________________________________
Please note, certain features may not be available at all hotel properties and cannot be guaranteed; however, we will make every
effort to accommodate your request.
Please return this questionnaire to the following address at least 60 days prior to your departure.
Princess Cruises, Attention Access Office Email: [email protected]

24305 Town Center Drive, Santa Clarita, CA 91355 Fax: 661-284-4408
Note: At ports where a tender is used, wheelchair/scooter access is limited and disembarkation is at the discretion of the Captain.
Privacy notice: We respect your privacy and the personal information you provide us in this mobility questionnaire will be treated with our privacy policy. In order to
facilitate your cruise, certain information may be required by and disclosed to certain organizations (e.g. fleet staff, or medical staff onboard) but only as necessary.
You can access the personal information we have collected about you and obtain a copy of our privacy policy from our Privacy Ofﬁcer. We will not be able to facilitate
the booking, carriage and administration of your cruise if you do not provide us with all the information requested on this form.

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This document contains both information and form fields.

To read information, use the Down Arrow from a form field.

_ _____________________ _ _____________________ _

_ _________________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _____________________ _ _ _____________________

Indicate type of device Device dimensions

Are you able to negotiate steps on and off of a motorcoach? Yes No

Are you able to transfer from your device to a seat? Yes No

Pre- and Post-cruise programs

I require Accessible hotel room? Yes No

Princess Cruises, Attention Access Office Email: [email protected]

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