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- I am seeking:*
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Format: 07000000000.
- Date of birth*
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- Sex*
- Sex (for pregnancy letter requests) - hidden*
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- Embarkation Date:*
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- Please indicate if you have ever been diagnosed with any of the following:*
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- Are you currently taking any regular medication or receiving ongoing treatment?*
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- Have you been hospitalised or had surgery in the past 5 years?*
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- Do you have any allergies (food, medication, etc.)?*
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- Do you currently smoke or use nicotine products?*
- How would you describe your alcohol consumption?*
- How would you rate your ability to walk or climb stairs without significant symptoms?*
- In an emergency situation, would you be able to move independently to a muster station?*
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- Have you had a reaction to a vaccine before?*
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- Do you have any known allergies?*
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- Do you have any existing or relevant medical conditions?*
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- Are you currently taking any medications or treatments?*
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- Have you already applied for a Blue Badge?*
- Are you applying for a new Blue Badge or renewing one?*
- Please select the category that best describes your main health condition or disability.*
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- How far can you usually walk before needing to stop or rest?*
- Which of the following symptoms affect your mobility or confidence when travelling?*
- Do you use any mobility aids such as a walking stick, crutches or wheelchair?*
- Do you usually need another person to assist you when travelling outside your home? *
- Are you currently under the care of a GP or specialist for this condition? *
- Have you received any recent treatment or surgery related to this condition? *
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- Start of Symptoms*
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- Select Request Type*
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- Outbound flight date*
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- Return flight date
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- How many medication are you traveling with? (Please note that your Partner Doctor can confirm you're traveling with up to 3 different medication per letter issued)*
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- Are you currently receiving any medical treatment, therapy, or taking medications related to your health condition?*
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- Do you want your Partner Practitioner to include health details and symptoms in your letter, or would you prefer a more generic approach to maintain privacy?*
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- Which type(s) of disability best describe your situation?*
- When was your condition first diagnosed or identified?*
- Is your disability permanent, long-term, or temporary?*
- What do you need this Disability Letter for?*
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- Are you currently receiving any medical treatment, therapy, or taking medications related to your disability?*
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- Do you want your Partner Practitioner to include health details and symptoms in your letter, or would you prefer a more generic approach to maintain privacy?*
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- Do you have any pre-existing health conditions your Partner Practitioner should be aware of?*
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- Are you taking any medications regularly?*
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- How far can you walk before you have to stop to catch your breath?*
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- Are you currently suffering from any infectious diseases?*
- Are you presently sick due to any infections?*
- Did you ever have any infectious diseases in the past that necessitated isolation?*
- Have you previously been diagnosed with Tuberculosis?*
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- When is your estimated delivery date?*
- Is your pregnancy single or multiple?*
- Did conception occur naturally or with the assistance of medical procedures (e.g., IVF, fertility treatments)?*
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- Have you experienced any complications or adverse events during your current pregnancy?*
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- Have you noticed any recent changes in your abdomen, such as pain, bloating, changes in bowel habits, or cramping?*
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- Have you recently experienced any chest discomfort, such as cough, chest pain, shortness of breath, or palpitations?*
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- Do you have a history of any of the following medical conditions?*
- Have you been medically advised that you are NOT at increased risk for conditions such as pre-eclampsia, hypertension, blood clots, or premature delivery?*
- Please confirm that your midwife does not advise against flying*
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- Are you currently on any prescribed medications?*
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- Please confirm whether you have been prescribed any medications to prevent blood clots (e.g., aspirin, heparin, or other anticoagulants).*
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- What was your Body Mass Index (BMI) at the onset of your pregnancy?*
- What was your latest antenatal clinic blood pressure reading?*
- When was your most recent blood pressure reading taken?*
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- Main reason for travel or holiday cancellation*
- Start date of symptoms*
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- Main reason for medical letter*
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- Do you want your Partner Practitioner to include health details and symptoms in your letter, or would you prefer a more generic approach to maintain privacy?*
- Have you sought medical care from your GP or local A&E for your medical issue?*
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- Can you confirm that over the last 48 hours, no new spots have appeared, and that all the chickenpox spots have now scabbed over?*
- Have you had any fever within the last 48 hours?*
- Have you been in contact with anyone with Monkeypox?*
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- Valid from*
- Valid to (inclusive)
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- Leave period starts before present date? (Hidden field)
- Current date
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- Flight Date
- Outbound flight date*
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- What is the duration of your flight?*
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- Do you have a return flight?*
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- Return flight date*
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- Should be Empty: