Health Requirements

 

MEDICAL HISTORY

To the Participant:

The purpose of this medical questionnaire is to find out if you Should be examined by your doctor before participating in recreational scuba diving. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician.

Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with a PADI Medical Statement and Guidelines for Recreational Scuba Dives Physical examination to take to your physician.

___ Could you be pregnant or are you attempting to become pregnant?

___ Do you regularly take prescription or nonprescription medications? (with the exception of birth control)

___ Are you over 45 years of age and have one or more 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...

    ___ Asthma, or wheezing with breathing, or wheezing with exercise?

    ___ Frequent or severe attacks of hayfever 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)?

    ___ Behavioral 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 (fuII/partial loss of consciousness)?

    ___ Do you frequently suffer from motion sickness (seasick, carsick, 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: walking one mile within 12 minutes)?

    ___ History of high blood pressure or take medication 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?

    ___ History of ear disease, hearing loss or problems with balance?

    ___ History of problems equalizing (popping) ears with airplane or mountain travel?

    ___ History of bleeding or Other blood disorders?

    ___ History of any type of hernia?

    ___ History of ulcers or ulcer surgery?

    ___ History of colostomy?

    ___ History of drug or alcohol abuse?