Assisted travel | Avanti West Coast

Personal details

Fields marked with ∗ are required

Title ∗ Title is required

First name ∗ First name is required Please enter proper characters

Last name ∗ Last name is required Please enter proper characters

Email ∗ Email is required Please enter a valid email address

Postcode

First line of address We are unable to submit your form with some of the special characters you’ve used entered

Second line of address We are unable to submit your form with some of the special characters you’ve used entered

City/town We are unable to submit your form with some of the special characters you’ve used entered

Country We are unable to submit your form with some of the special characters you’ve used entered

Contact number Please enter proper phone number

Preferred method of contact ∗ Preferred method of contact is required

Are you travelling with a companion?

Companion name We are unable to submit your form with some of the special characters you’ve used entered

Companion contact number Please enter proper phone number

Required assistance

Avanti West Coast train services can carry manual or powered wheelchairs up to the following dimensional and weight limitations: Width 700mm, Length (including footplates) 1200mm, Weight (including passenger) 300kg.

Which point of the journey do you require assistance? ∗ Which point of the journey do you require assistance? is required

Are you travelling with an assistance dog?

If other please give details We are unable to submit your form with some of the special characters you’ve used entered

Sensory/Mobility impairment

Visual Impairment
Speech Impairment
Hard of hearing/Deaf
Accompanied by Assistance Dog
Mobility - no ramp required
Mobility - ramp required
Mobility - wheelchair required at the station
Mobility - wheelchair to seat transfer required

Other Impairment

Dyslexia
Autism
Dementia
Accompanies by Assistance dog
Learning difficulties
Mental health condition
Non-verbal
Other

Mobility

Do you require a Wheelchair space?

A colleague will contact you shortly

If you selected "other" please specify details We are unable to submit your form with some of the special characters you’ve used entered

If other, specify details We are unable to submit your form with some of the special characters you’ve used entered

Some stations provide a buggy service, if this service is available at any of the stations you are travelling from, would you like to use a buggy?

Yes

Do you require help with your luggage?

Yes

Is there any additional information you would like us to know? (wheelchair/scooter details, any specific assistance you require etc.) (5000 characters maximum)

You are unable to use the following special characters when submitting this form ()[]{}+=#^;<>~

Please help us to protect your data by NOT sharing any bank account, or other payment details in this form

We are unable to submit your form with some of the special characters you’ve used entered

Outward journey

Booking reference (if applicable) We are unable to submit your form with some of the special characters you’ve used entered

Journey origin ∗

Journey origin is required

Journey destination ∗

Journey destination is required

Scheduled departure date ∗ Scheduled departure date is required Departure date should be less than arrival date

Scheduled departure time ∗ Scheduled departure time is required

Via ( which station are you changing at? )

If reservations already held, please advise carriage and seat number We are unable to submit your form with some of the special characters you’ve used entered

How are you arriving at your origin station?

If you selected "other" please specify details We are unable to submit your form with some of the special characters you’ve used entered

How are you departing from your destination station?

If you selected "other" please specify details We are unable to submit your form with some of the special characters you’ve used entered

Are you returning?

Return journey

Journey origin ∗

Journey origin is required

Journey destination ∗

Journey destination is required

Scheduled departure date ∗ Scheduled departure date is required Return date should be greater than outward date

Scheduled departure time ∗ Scheduled departure time is required

Via

If reservations already held, please advise carriage and seat number We are unable to submit your form with some of the special characters you’ve used entered

How are you arriving at your origin station?

If you selected "other" please specify details

How are you departing from your destination station?

If you selected "other" please specify details We are unable to submit your form with some of the special characters you’ve used entered

From time to time we need to share passenger assist data with the rail regulator and their research suppliers to conduct research in order to drive customer journey improvements. do you agree to be contacted regarding your experience? ∗ From time to time we need to share passenger assist data with the rail regulator and their research suppliers to conduct research in order to drive customer journey improvements. do you agree to be contacted regarding your experience? is required

I agree to the terms and conditions. ∗ I agree to the terms and conditions. is required

Passenger Assist

Personal details

Fields marked with ∗ are required

Required assistance

Outward journey

Return journey