Diver Medical Participant Questionnaire

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/ or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.

Directions

Complete this questionnaire as a prerequisite to a recreational scuba diving or freediving course.
Note to women: If you are pregnant, or attempting to become pregnant, do not dive

*If you answered YES to question 3, 5 or 10 above OR to any of the question in the Second Section of this form, please read and agree to the Participant Confirmation above download the Medical Examiner Evaluation Form and take it together with this filled form you will receive via email to your physician for a medical evaluation. Participation in a diving course requires your physician’s approval.
Second Section is visible only if you need to answer some other question.

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*Physician’s medical evaluation required (see Participant Confirmation)

*Physician’s medical evaluation required (see Participant Confirmation)

*Physician’s medical evaluation required (see Participant Confirmation)

*Physician’s medical evaluation required (see Participant Confirmation)

*Physician’s medical evaluation required (see Participant Confirmation)

*Physician’s medical evaluation required (see Participant Confirmation)

*Physician’s medical evaluation required (see Participant Confirmation)