RosesSub
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.
Please fill in the fields with your personal information:
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 NO to all 10 questions above, a medical evaluation is not required. Please read and agree to the participant statement below by signing and dating it.
* If you answered YES to questions 3, 5, or 10 above, or to any of the questions that appear after checking YES to any of the remaining questions on the form, please read and agree to the above statement by dating and signing it and bring the Physician Evaluation Form (Participant Questionnaire and the Physician’s Evaluation Form) to your physician for a medical evaluation. Participation in a diving course requires your physician’s approval.
Furthermore, I agree to inform the dive center during the season if my health status changes and the answers to this questionnaire are modified as a result.
