Frequent medical traveler – Bahrain Airline

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Before You Fly

Medical Cases

FREQUENT TRAVELLER'S MEDICAL APPLICATION FORM

This form is intended to provide medical information, to enable Gulf Air Medical Department to issue a Frequent Traveller's Medical Card.

Passenger Details:

Title

First name

Family name

Permanent Address:

Country code (eg: 973)

Area code & Main number
(eg: 17 123456)

Mobile Telephone:

Home:

Business:

Email:

Sex:

Age:

Date of onset of illness:

Diagnosis:

Oxygen Requirements:

Remarks:

Wheelchair requirements (please tick one if applicable):

	WCHC:	Wheelchair – C for Cabin Seat. Passenger completely immobile. Requires wheelchair to/from aircraft/mobile lounge and must be carried up/down steps and to/from cabin seat.
	WCHR:	Wheelchair - R for Ramp. Passenger can ascend/descend steps and make own way to/from cabin seat, but requires wheelchair for distance to/from aircraft, i.e. across ramp, fingerdock or to mobile lounge, as applicable.
	WCHS:	Wheelchair - S for Steps. Passenger cannot ascend/descend steps, but is able to make own way to/from cabin seat; requires wheelchair for distance to/from aircraft or mobile lounge and must be carried up/down steps.
	WCOB:	On-board Wheelchair

Special Meals Request
Seat Request:	Aisle Window

Assistance required inflight:

Does the passenger travel with or without an escort?

with without

Doctor Details:

*	First name
*	Family name
*	Business Telephone
*	Mobile telephone
*	Email

Notes:

Cabin Staff are trained on First Aid only and the First Aid Kits carried aboard aircraft do not contain syringes, surgical instruments or special drugs. Except in cases of emergency, cabin staff are not permitted to administer any injections.
Therapeutic Oxygen can be provided if requested at least 3 days in advance through any Gulf Air Office.
Any fee for completion of this form will be the responsibility of the passenger.
Gulf Air reserves the right to reject any application.

* Required Fields

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