Diving medical information

Detailed below is a medical questionnaire designed to highlight any existing problems that might affect you while diving. A positive response to any of the questions does not necessarily disqualify you from diving, but does mean you should consult a medical physician before participating in Scuba Diving.

Answer the following questions truthfully about your past and present health. If you are in any doubt whatsoever about any of the questions, answer yes. If any of these statements apply to you, please consult a medical physician.

• Could you be pregnant or are you attempting to become pregnant?
• Do you regularly take prescription or non-prescription medications? with the exception of birth control)
• Are you over 45 years old and have one of the following:
  • Currently smoke a pipe, cigars or cigarettes?
  • Have a high cholesterol level?
  • Have a family history of heart attacks or strokes?
• Have you ever had or do you currently have either:
  • 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)?
  • History of chest surgery?
  • Claustrophobia or Agoraphobia (fear of closed or open spaces)?
  • Behavioural health problems?
  • Epilepsy, seizures, convulsions or take medications to prevent them?
  • Recurring migraine headaches or take medications to prevent them?
  • History of blackouts or fainting (full / partial loss of consciousness)?
  • Do you frequently suffer from motion sickness, (seasickness, carsickness etc)?
  • History of diving accidents or decompression sickness?
  • History of recurrent back problems?
  • History of back surgery?
  • History of Diabetes?
  • History of back, arm or leg problems, following surgery, injury or fracture?
  • Inability to perform moderate exercise (example walk one mile within 12 minutes)?
  • History of high blood pressure or take medicine to control blood pressure?
  • History of any heart disease?
  • History of heart attacks?
  • Angina or heart surgery or blood vessel surgery?
  • History of ear or sinus surgery?

NB This medical questionnaire is intended as a guide only