IMPORTANT INFORMATION

Tropical Cyclone Debbie

Planning

Special Service Request Form

Please complete this form for each person requesting special assistance. Details for additional persons can be added once this request is submitted.

To help you assess whether a request should be made, please review our information on Independent Travel Criteria.
  
If you have recently had surgery or have a medical condition you may require clearance to travel. Please review our Medical Clearance guidelines

Section Title

Please enter a valid reservation number (6 letters).



Contact Phone Number




Assistance Information

Please complete the sections that apply to your needs

Vision Impairment Details

Please complete this option if you require assistance for vision impairment and did not add a request when making your booking.

Vision Impairment Details




Max 3000 characters.

Please also read our information about travelling with a service dog

Hearing Impairment Details

Please complete this option if you require assistance for hearing impairment and did not add a request when making your booking.

Hearing Impairment Details




Max 3000 characters.

Please also read our information about travelling with a service dog

Service Animal Details

Please complete this section if you are travelling with a service animal in the cabin that is not a service animal included in the vision or hearing impairment section.

Service Animal Details


Max 3000 characters.

Wheelchair Assistance

Please complete this option if you require wheelchair assistance and did not add a request when making your booking. If you are immobile, you may require assistance when travelling. Please refer to our Independent Travel Criteria.

If you are travelling with a carer or require an assistance person, please complete the section Travelling with a Carer or Providing an Assistance Person.

Wheelchair Assistance








Max 3000 characters.

Please also read our information about size and weight requirements for Mobility Aids and Medical Conditions.

Travelling with a carer or providing an assistance person

Please complete this section if you are travelling with a carer to assist in flight, or will be providing an assistance person to help with transferring to or from your seat. Please also read our information on Mobility Assistance and Independent Travel Criteria.

Travelling with a carer or providing an assistance person





Max 3000 characters.

Carer Details

Carer Details





Contact Phone Number



Assistance Person Details

Departure Assistance Person

Assistance Person Details




Contact Phone Number



Arrival Assistance Person

Assistance Person Details




Contact Phone Number



Medical condition that may require medical clearance

Please complete this section if you have a medical condition that may require medical clearance. Please also read our information regarding Special Medical Needs and Medical Clearance Guidelines (PDF 324KB) as you may be required to supply further information or to complete a Medical Clearance Form (available as part of the Medical Clearance Guidelines (PDF 324KB) ) and present it at check-in.

Medical condition that may require medical clearance


Max 3000 characters.

Travelling with powered medical equipment for use on board

If you are travelling with powered, battery operated or other medical equipment or assistive devices for use onboard, please complete the following section.

Please also read our information about travelling with Medical Conditions and about travelling with Medical Equipment. To ensure that your equipment is suitable for travel, you may also be required to complete a Personal Medical Equipment form.

If you have completed a Personal Medical Equipment form, please attach it before submitting your request.

Travelling with powered medical equipment for use on board






Max 3000 characters.

Other assistance and additional information

If you require any other assistance or have any additional information in regard to this request, such as the following, please include it here:

  • Specific seating requirements for a disability or injury (e.g. to accommodate a leg fracture or fused knee cap)
  • Need a removable arm rest

Other assistance and additional information

Max 3000 characters.

We are collecting your personal information. Please read our relevant Privacy Statement which is available at www.virginaustralia.com/privacy for information about how we will handle this information, our likely overseas disclosures and how you can access or correct your personal information or make a privacy complaint.