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Dive Info
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Scuba Diving Medical Form - diver
clearance
Check
your physical diving suitability here.
The
purpose of this medical questionnaire is to find out if a doctor should examine
you before participating in recreational scuba diving. A positive response to a
question does not necessarily disqualify you from diving, it means that there is
a pre-existing condition that may affect your safety while diving and it is
necessary to seek the advice of a physician. Please read the following questions
and answer them honestly. If you answer "YES" to any of them then
consult a physician prior to participating in dive training. Please note that
this is a precautionary measure - many that are required to see a doctor can
indeed scuba dive.
- Could
you be pregnant or are you attempting to become pregnant?
- Do
you regularly take prescription or nonprescription medication?
(with the exception of birth control or anti-malaria)
- Are
you over 45 years of age and have one or more of the following?
- Currently
smoke a pipe, cigars or cigarettes?
- Have
a high cholesterol level?
- Have
a family history of heart attacks or strokes?
- Are
currently receiving medical care?
- High
blood pressure?
- Diabetes
mellitus, even if controlled by diet alone?
Have
you ever had or currently have ...
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- Asthma, or
wheezing with breathing, or wheezing with exercise?
- Frequent
or severe attacks of hay fever or allergy?
- Frequent
colds, sinusitis or bronchitis?
- Any
form of lung disease?
- Pneumothorax
(collapsed lung)?
- Other
chest disease or chest surgery?
- Behavioral
health, mental or psychological problems?
- (Panic
attack, fear of closed or open spaces)?
- Epilepsy,
seizures, convulsions or take medications to prevent them?
- Recurring
complicated migraine headaches or take medications to prevent them?
- Blackouts
or fainting (full/partial loss of consciousness)?
- Do
you frequently suffer from severe motion sickness (seasick, carsick etc.)?
- Dysentery
or dehydration requiring medical interventions?
- History
of diving accidents or decompression sickness?
- inability
to perform moderate exercise (example: walk 1.6 km/one mile within 12
minutes)?
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- Head
injury with loss of consciousness in the past 5 years?
- Recurrent
back problems?
- Back
or spinal surgery?
- Diabetes?
- Back,
arm or leg problems following surgery, injury or fracture?
- High
blood pressure or take medications to control blood pressure?
- Heart
disease?
- Heart
attacks?
- Angina
or heart surgery or blood vessel surgery?
- Sinus
surgery?
- Ear
disease, hearing loss or problems with balance?
- Recurrent
ear problems?
- Bleeding
or other blood disorders?
- Hernia?
- Ulcers
or ulcer surgery?
- Colostomy
or ileostomy?
- Recreational
drug use or treatment for, or alcoholism in the past 5 years?
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