More About You
Name (first, last): *
Address: *
Country: *
Telephone: *
Work telephone:
Mobile No:
Email: *
Best time to call:
Language(s) spoken:
Which International Airport(s) would you be departing from:
Preferred dates of travel:
	Between and
I don't know exactly but between the next:
	3 months6 months9 months
Do you want to plan for a few days to enjoy the country before/after your medical requirements:
	YesNo
Will you need any special assistance from your airline ie wheelchair or dietary requirements:
The following questions will help us arrange your accommodation while you are here:
How many people will you be traveling with:
Number of children:
Do you want separate room:
	YesNo
Do you prefer your accommodation to be near:
	Clinic/SurgeryParksCafe/RestaurantsShopping
When it comes to your accomodation what is most important for you please write:
	Price Area All inclusive (provides food and beverages) Spa services Mini Fridge Casino Shopping Activities Peace and quiet
Do you have any special dietary requirements the hotel will need to be aware of:
Tours and things to do while you are here
What you are able to do and see while you are here will of course depend on your medical procedure. The following list will give you an idea of the options you or your travel companions have during your stay.
Action Activities:
	Shopping Museums Movies/Theatres Casinos Night Club Tours Danube Tours Historical Tours Archeological Tours Cultural Tours Eco Tours Health Spa Tours Relaxing Tours Countryside Tours
Additional Comments:
* required fields
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