Accessibility Survey

This is a Lacroix Experience Survey. If you travel to an all accessible resort, please indicate what you would like to expect or/need during your stay.

1.) For your bedroom:
O Wide doors, Automatic entry door, Adjustable bed height
O 1 bed, 2 beds, Hospital bed
O Hoyer lift, Grab bar above the bed, Trapeze
O Emergency cord, 5 foot turnaround, Connecting rooms
O Tight weave carpet or no carpet
O Other _________________________________________________________________________
______________________________________________________________________________

2.) For your bathroom:
O Roll in shower, Attached shower seat with arms
O Attached shower seat without arms, Separate shower seat, Grab bars in shower
O Adjustable shower head height, High liner toilet, Commode seat raiser
O Grab bar to the right of the toilet, Grab bar to the left of the toilet, Low toilet
O Sink open under counter
O Other:_________________________________________________________________________
_______________________________________________________________________________

3.) For the restaurant or dining:
O Correct height table with extensions, Specific tables for wheelchairs on aisles
O Wide walkways between tables, Turn around space
O Buffet table at correct height
O Other: _________________________________________________________________________
_______________________________________________________________________________

4.) Other requirements you would require to allow your stay to be comfortable:
O TTY on phone, Speak the floor level in the elevator, Braille
O Flashing light for emergency, Hire a care assistant, Accessible van rental
O Other:_________________________________________________________________________
______________________________________________________________________________

5.) Where are the top destinations you would vacation:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

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