Medical History
Questionnaire
The purpose of this medical history
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 pre-existing condition that may affect
your safety while diving and you must seek the advice of a physician.
The following questions should be
answered based on your past and present medical history with a YES or
NO. If you are not sure answer YES. If any of these items apply to you,
we request that you consult a physician prior to participating in scuba
diving. This list is not exhaustive just
a general guideline. You will fill out an exhaustive medical statement
prior to starting the course. If you answer YES to any questions on
the exhaustive PADI medical statement you must get cleared by a Physician
prior to beginning any water training.
• Do
you currently have an ear infection?
• Do
you have a history of ear disease, hearing loss or problems with balance?
• Do
you have a history of ear or sinus surgery?
• Are
you currently suffering from a cold, congestion, sinusitis or bronchitis?
• Do
you have a history of respiratory problems, severe attack of hayfever
or allergies, or lung disease?
• Have
you had a collapsed lung (pneumothorax) or history of chest surgery?
• Do
you have active asthma or history of emphysema or tuberculosis?
• Are
currently taking medication that carries a warning about any impairment
of your physical or mental abilities?
• Do
you have behavioral health problems or a nervous system disorder?
• Are
you, or could you be pregnant?
• Do
you have a history of colostomy?
• Do
you have a history of heart disease or heart attack, heart surgery,
or blood vessel surgery?
• Do
you have a history of high blood pressure, angina, or take medication
to control blood pressure.
• Are
you over 45 and have a family history of heart attack or stroke?
• Do
you have a history of bleeding or other blood disorders?
• Do
you have a history of diabetes?
• Do
you have a history of seizures, blackouts or fainting, convulsions or
epilepsy or take medications to prevent prevent them?
• Do
you have a history of back, arm or leg problems following an injury,
fracture or surgery?
• Do
you have a history of fear of closed or open spaces, or panic attacks
(claustrophobia or agoraphobia)?
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