Diver Medical Form

Enter your Diver Registration reference code to auto-fill your details, then answer the medical questionnaire honestly.

Registration Reference

From the email sent after your Diver Registration.

Participant Questionnaire

1. I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19.

2. I am over 45 years of age.

3. I struggle to perform moderate exercise (for example, walk 1.6 km/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.

4. I have had problems with my eyes, ears, or nasal passages/sinuses.

5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.

6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.

7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.

8. I have had back problems, hernia, ulcers, or diabetes.

9. I have had stomach or intestine problems, including recent diarrhea.

10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).

Consent Declaration (replaces signature)

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions. Note to women: If you are pregnant, or attempting to become pregnant, do not dive. If you answered YES to questions 3, 5 or 10 OR to any follow-up box questions, physician evaluation may be required. Please upload physician approval if available.

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