Limitless Journeys Travel Advisors – Differently Abled Questionnaire Travel Agency Client Questionnaire Thank you for choosing Limitless Journeys Advisors and Travel. The responses provided will help us create the most comfortable and enjoyable experience for the traveler. Personal InformationFull NamePreferred NameEmail Phone NumberEmergency Contact Phone NumberEmergency Contact NameAddress(Required)Preferred Method of Communication: Phone Email Text Message Travel Preferences Please provide details about your travel plans and preferences below.Preferred Travel Destination(s)How many people are traveling?Travel DatesFromDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ToDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Reason for Travel: Leisure/Vacation Family Visit Medical Treatment Business/Work Special Event (please specify): Other (please specify): Preferred Mode of Transportation (Check all that apply): Airplane Train Cruise Ship Car/Truck/Van (circle one) Rental Needed? Preferred Accommodation Type: Hotel Resort Vacation Rental Accessible Lodge Other (please specify) Budget $ Ages of all travelersPlease specifyPlease specifyPlease specifyPlease specifyPlease specifyPlease specifyMobility Challenges: Yes (please specify): No Please specifyWheelchair-Accessible Accommodations or Transportation Needed: Yes (please specify): No Please specifyAssistance with Navigation or Orientation: Yes (please specify): No Please specifySensory Sensitivities (e.g., noise, light, crowds): Yes (please specify): No Please specifySpecialized Equipment Required (e.g., oxygen, CPAP, hearing aids, service animal support): Yes (please specify): No Please specifyDietary Restrictions or Allergies: Yes (please specify): No Please specifyCompanion & Support NeedsWill the traveler be accompanied by a caregiver or support person? Yes No Will the traveler require assistance from trained staff at any point during the trip? Yes No Communication PreferencesDoes the traveler use assistive communication devices or require alternative communication methods? Phone Email Text Message Emergency Preparedness Are there specific emergency protocols or medical contacts that should be kept on file during travel? Does the traveler have a personal emergency plan or medical documentation they would like to share? Provide details herePreferred Travel Pace & Energy LevelsHow would the traveler describe their ideal travel pace? Relaxed and slow-paced Moderately active with breaks Fast-paced with minimal downtime Room Requirements Walk-in Shower Tub Crib UntitledAccessibility at DestinationsAre there specific accessibility features the traveler requires at hotels or attractions (e.g., roll-in showers, elevator access, quiet spaces, pool lift, chair, etc.)?Does the traveler prefer guided tours or independent exploration with accessibility accommodations?Cultural & Social ConsiderationsAre there cultural preferences or sensitivities the traveler would like to be considered?Does the traveler prefer group activities, private experiences, or a mix?Medical & Health ConsiderationsMedical Assistance or Special Support Needed During Travel: Yes (please specify): No Please specifyTravel Insurance with Medical Coverage Required: Yes No Additional Preferences & RequestsActivities or Experiences the Traveler Would Like to Include in the Trip (e.g., guided tours, show or sports tickets, relaxation, adventure, accessible attractions):Additional Accommodations or Requests the Traveler Would Like Us to Arrange:CAPTCHA
