Medical Self Declaration Form

All passengers scuba diving whilst on holiday are required to be fit to dive. All divers will be required to complete and sign a medical questionnaire. If our dive guides are in any way unsure of your fitness to dive, you will be required to undergo a medical examination. This may result in considerable extra cost for which you will be charged locally. No refunds will be given if you are refused medical clearance to dive. You are strongly advised to undergo a full medical examination before booking your holiday, and you must do so if you reply in the positive to any of the questions in the following questionnaire. If you currently hold a diving medical be sure you take it with you.

Could you be pregnant or are you attempting to become pregnant?
Do you regularly take prescription or non-prescription medications?

If you answer yes to any of the following questions you will need medical clearance from a doctor before you can dive:

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 stroke?

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 or any form of lung disease?
Pneumothorax (collapsed lung)?
History of chest surgery?
Claustrophobia or agoraphobia (fear of closed or open spaces)?
Behavioural 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 (full/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 or back surgery?
History of diabetes?
History of back, arm or leg problems following surgery, injury or fracture?
Inability to perform moderate exercise (walk 1 mile within 10 min)?
History of high blood pressure or take medicine to control blood pressure?
History of any heart disease or heart attacks?
Angina (heart or blood vessel surgery)?
History of ear or sinus surgery?
History of problems equalizing, popping ears with aeroplane or mountain travel?
History of bleeding or other blood disorders?
History of any type of hernia?
History of colostomy?
History of drug or alcohol abuse?

Vaccination and health requirements vary from country to country. Your own GP is the best person to speak to regarding relevant requirements. Make your GP aware that you will be scuba diving as some medication is not recommended for scuba divers.