(as appears on the Discover Scuba Diving form, which you must complete and sign before starting the course):


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 & Guidelines for Recreational Scuba Diver's Physical Examination to take to your physician.


Have you suffered from, or do you now suffer from, any of the following:


Are you currently suffering from:


    Asthma or wheezing?

    Breathlessness?


    Fainting, seizures or blackouts?

    Chronic Ear Discharge or infection?



    Chronic Bronchitis or persistent chest complaints?

    High Blood Pressure?


    Chronic sinus conditions?

    Perforated Eardrum?


    Chest surgery?

    Other illness or operation within the last month?


    Recurrent ear problems when flying?

    Are you currently taking any medicine or drug (excluding oral contraceptives)?


    Epilepsy?

    Have you ingested any alcohol within the last 8 hours prior to diving?


    Diabetes Mellitus? (sugar diabetes)

    Are you pregnant?


    Tuberculosis or other long-term lung disease?


    Brain, spinal cord or nervous disorder?


    Heart disease of any kind?


    Collapsed lung (pneumothorax)?


    Ear surgery?


    Do you understand that any concealment of any condition incompatible with safe diving might put your health or life at risk?


    Do you understand that you should not go to altitude (fly) within 12 hours of completing a single dive or 18 hours when doing multiple dives (where possible wait 24 hours)?