Medical Questionnaire

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Medical Form Submitted(Required)

Yes

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Medical Clearance Status (admin only)(Required)

Approved

Awaiting Approval

Registration Entry ID (admin only)(Required)

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Medical Team Notes

Name(Required)

Prefix First Last

Contact Number(Required)

By providing these details, you agree to being contacted by this method.

Contact Email(Required)

By providing these details, you agree to being contacted by this method.

Age at Time of Travel

Please put your age as of 17th July 2026

Details of your Global or European Health Insurance Card(Required)

Enter the LONG Identification number of the card, NOT the short Personal ID Number. If you do not have a valid card, type TBA, and relay by email the number along with the card’s expiry date to the Pilgrimage Office when you have them. You must have a valid GHIC or EHIC to validate your travel insurance. You should safely keep your card with you while in France.

Card's Expiry Date(Required)

If you do not have a valid card, enter 01 01 1999, and relay by email the expiry date along with the card’s number to the Pilgrimage Office when you have them.

Doctor's Name(Required)

Doctor's Phone Number(Required)

GP Address(Required)

Street Address Address Line 2 City Post Code Country

Medical Form Section 1 – Healthcare Contact Details

Hospital / NHS Number

Do you have a Hospital Consultant or other Clinical Team?(Required)

Yes

No

Hospital Consultant / Clinical Team Name

Hospital Consultant / Clinical Team Telephone

By you providing these details, they agree to being contacted by this method.

Medical Information Upload

Please upload any relevant medical documents.

Drop files here or

Accepted file types: pdf, doc, docx, img, png, jpg, jpeg, Max. file size: 16 MB.

Is there anything else you need to tell us? Please use the blank space below.

Protecting your privacy:

Your personal details will be stored and used by the Diocese of Westminster for the purposes of running and administering the Lourdes Pilgrimage. Details of how the Diocese processes your data, and your rights, are in the full privacy notice, which can be found at: https://rcdow.org.uk/privacy/.

The medical information you have provided must be shared with the Pilgrimage Medical Team for the purposes of running and administering the pilgrimage. By submitting this form, you are indicating that:

You have provided accurate information about any medical condition(s), restricted mobility, or disability/ies you have;
You consent to the Pilgrimage Team contacting any of your pre-existing healthcare professionals for the assessment of your health and medical needs during the Pilgrimage;
And that you consent to the sharing of any medical information with other healthcare professionals, either in France or the UK, in the interests of ensuring your on-going health and medical needs are met.

Additionally, for those who are booking a pilgrimage package through Westminster Diocese and Tangney Tours, the mobility needs you have provided must be shared with our tour operator, Tangney Tours, for the purposes of running and administering the pilgrimage. By submitting this form, you are indicating that:

You have read and understood the Tangney Tours’ Booking Terms & Conditions and that you accept them on your own behalf and/or are authorised to accept them on behalf of the other travellers named on the form.

Medical Form Section 1 – Healthcare Contact Details

Medical Form Section 2 – Travel Arrangements

In the UK

During Travel

In Lourdes

Medical Form Section 2 – Medical History

Medical Information Upload