Questionnaire – NeuroDiverse Travel Co.

NeuroDiverse Travel Co.

Home
Destinations
- South Africa
- Namibia
- Zambia
- Botswana
Types of Tours
About us
Contact
Memberships & Affiliations
Pre-Trip Questionnaire

NeuroDiverse Travel Co.

Home
Destinations
- South Africa
- Namibia
- Zambia
- Botswana
Types of Tours
About us
Contact
Memberships & Affiliations
Pre-Trip Questionnaire

Neurodiverse Traveller Pre-Trip Questionnaire

Confidential: All responses are private and used solely for inclusive trip planning.

Traveller Details Full Name:

Date of Birth:

Preferred Name / Pronouns:

Email:

Contact Number:

Emergency Contact Name:

Phone Number:

Relationship:

If Completed by Guardian Your Name:

Relationship to Traveller:

Your Email:

Neurodiversity Profile Diagnosed or self-identified condition(s):
Autism Spectrum Disorder (ASD)
ADHD / ADD
Sensory Processing Disorder
Tourette Syndrome
Anxiety / Social Anxiety
PTSD / Trauma-related
Other:

Sensory Needs Sensitivities:
Bright lights
Loud noises
Crowds
Strong smells
Physical contact
Temperature
Other:

Helpful Sensory Inputs:

Tools or aids used:

Travel Preferences & Triggers Situations to avoid:

Known triggers:

Calming strategies:

Meltdown protocol:

Communication & Social Needs Preferred communication style:

Processing delays or response needs?

Social preference:

Medical & Dietary Information Food allergies or dietary restrictions:

Medications (include times and any reminders needed):

Medical conditions:

Expectations and Boundaries Activities the traveller would like to do:

Activities to avoid:

How can we best support the traveller if overwhelmed?

Additional information:

Consent I confirm that the information provided is accurate and consent to its use for travel planning.

Name of person completing this form:

Date:

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Neurodiverse Travel Co.

Created by Brackie Guide

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NeuroDiverse Travel Co.

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