The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a pre-existing condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in diving activities.

Please take a look at the following questions:

Could you be pregnant, or are you attempting to become pregnant? Yes / No

Are you recently taking prescription medicines? (With the exception of birth control or anti-malarial) Yes / No

Have you ever had or do you currently have...

Asthma, or wheezing with breathing, or wheezing with exercise? Yes / No

Frequent or severe attacks of hayfever or allergy? Yes / No

Frequent colds, sinusitis or bronchitis? Yes / No

Any form of lung disease? Yes / No

Pneumothorax (collapsed lung)? Yes / No

Other chest disease or chest surgery? Yes / No

Behavioural health, mental or psycological problems (panic attack, fear of closed or open spaces)? Yes / No

Epilepsy, seizures, convulsions or take medications to prevent them? Yes / No

Recurring complicated migraine headaches or take medications to prevent them? Yes / No

Blackouts or fainting (full/partial loss of consciousness)? Yes / No

Frequent or sever suffering from motion sickness (seasick, carsick etc)? Yes / No

Dysentery or dehydration requiring medical intervention? Yes / No

Any dive accidents or decompression sickness? Yes / No

Inability to perform moderate exercise? Yes / No

Head injury with loss of consciousness in the past five years? Yes / No

Recurrent back problems? Yes / No

Back, arm or leg problems following surgery, injury or fracture? Yes / No

High blood pressure or take medicine to control blood pressure? Yes / No

Heart disease? Yes / No

Heart attack? Yes / No

Angina, heart surgery or blood vessel surgery? Yes / No

Sinus surgery? Yes / No

Ear disease or surgery, hearing loss or problems with balance? Yes / No

Recurrent ear problems? Yes / No

Bleeding or other blood disorders? Yes / No

Hernia? Yes / No

Ulcers or ulcer surgery? Yes / No

A colostomy or ileostomy? Yes / No

Recreational drug use or treatment for, or alcoholism in the past five years? Yes / No