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Pro Dive Magnetic Island
  • About Us
    • Meet the Team
    • Frequently Asked Questions
    • Terms and Conditions
    • Contact Us
  • Boat Trips
    • Great Barrier Reef
    • SS Yongala Wreck
  • Dive Courses
    • Open Water Diver
    • Continuing Education
      • Advanced Diver
      • Rescue Diver
      • Specialties
        • Boat Diver
        • Deep Diver
        • Enriched Air Nitrox
        • Navigation
        • Perfect Buoyancy
        • Search and Recovery
        • Wreck Diver
    • Professional Courses
      • Dive Master
      • Dive Instructor
      • SSI Crossover
      • Internship
    • Scuba Skills Update
    • First Aid, CPR & O2
  • Medical
    • Dive Medical Questionnaire
  • Sea School
  • Home
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  • Dive Medical Questionnaire

Dive Medical Questionnaire

18/06/2016 Written by MADivers

Divers Medical Questionnaire

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in scuba diving activities.  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 or the safety of others while diving and you must seek the advice of your physician prior to engaging in dive activities.

Name Email
Could you be pregnant, or are you attempting to become pregnant?
Are you presently taking prescription medications? (with the exception of birth control or anti-malarial)
Are you over 45 years of age?
Do you have a BMI over 30 and a waist circumference greater than 102cm for males and 88cm for Females?
Are currently receiving medical care?
Have you ever had or do you currently have...

Asthma, or wheezing with breathing, or wheezing with exercise?
Any form of lung disease?
Pneumothorax (collapsed lung)?
Other chest disease or chest surgery?
Behavioral health, mental or psychological problems (Panic attack, fear of closed or open spaces)?
Epilepsy, seizures, convulsions or take medications to prevent them?
Recurring complicated migraine headaches or take medications to prevent them?
Blackouts or fainting (full/partial loss of consciousness)?
Frequent or severe suffering from motion sickness (seasick, carsick, etc.)?
Dysentery or dehydration requiring medical intervention?
Any dive accidents or decompression sickness?
Inability to perform moderate exercise (example: walk 1.6 km/one mile within 12 mins)?
Head injury with loss of consciousness in the past five years?
Recurrent back problems?
Back or spinal surgery?
Diabetes?
Back, arm or leg problems following surgery, injury or fracture?
High blood pressure or take medicine to control blood pressure?
Heart disease?
Heart attack?
Angina, heart surgery or blood vessel surgery?
Sinus surgery?
Ear disease or surgery, hearing loss or problems with balance?
Recurrent ear problems?
Bleeding or other blood disorders?
Hernia?
Ulcers or ulcer surgery?
A colostomy or ileostomy?
Recreational drug use or treatment for, or alcoholism in the past five years?

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition.



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