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Certified Diver Medical Questionnaire

Certified Diver Medical Questionnaire

Name

First

Last

IMPORTANT: PLEASE READ

Since completing your last dive medical have you suffered any illness, injury or surgery that may effect your ability to dive safely?

Yes

Please List:

Are you currently suffering any illness or injury?

Yes

Please List:

Are you currently taking any prescription medication other than the contraceptive pill?

Yes

Please List:

Is there any other condition, fact or circumstance that may affect your fitness or ability to dive safely?

Yes

Please List:

ACKNOWLEDGEMENT: Please read carefully

I have read, understood and agree to the above points

If you are human, leave this field blank.

Open Water Courses: Start time: 9:00am - All customers meet at the Pro Dive Magnetic Island center (43 Sooning Street, Nelly Bay) Finish time: approx. 4:00pm * NOTE. If you are coming from Townsville you will need to take the 7:45am Sealink passenger ferry to Magnetic Island. the dive center is approx. a 15 minute walk from the ferry terminal.

Certified Diver Medical Questionnaire

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