Medical questionnaire for Scuba Diving and Snuba

 

The purpose of this medical history questionnaire is to find out if you should be examined by a 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 preexisting condition that may affect your safety while diving and you must seek the advice of a physician. If any of these items apply to you, consult with a physician prior to participating in scuba diving.

  1. Do you currently have an ear infection?
  2. Do you have a history of ear disease, hearing loss or problems with balance?
  3. Do you have a history of ear or sinus surgery?
  4. Are you currently suffering from a cold, congestion, sinusitis or bronchitis?
  5. Do you have a history of respiratory problems, severe attack of hayfever or allergies, or lung disease?
  6. Have you had a collapsed lung (pneumothorax) or history of chest surgery?
  7. Do you have active asthma or history of emphysema or tuberculosis?
  8. Are you currently taking medication that carries a warning about any impairment of your physical or mental abilities?
  9. Do you have behavioral health problems or a nervous system disorder?
  10. Are you or could you be pregnant?
  11. Do you have a history of colostomy?
  12. Do you have a history of heart disease or heart attack, heart surgery or blood vessel surgery?
  13. Do you have a history of high blood pressure, angina, or take medication to control blood pressure
  14. Are you over 45 and have a family history of heart attack or stroke?
  15. Do you have a history of bleeding or other blood disorders?
  16. Do you have a history of diabetes?
  17. Do you have a history of seizures, blackouts or fainting, convulsions or epilepsy or take medications to prevent them?
  18. Do you have a history of back, arm or leg problems following an injury, fracture or surgery?
  19. Do you have a history of fear of closed or open spaces or panic attacks (claustrophobia or agoraphobia)?

A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of a physician. If any of these items apply to you, consult with a physician prior to participating in scuba diving.

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TEL: (808) 256-8956

Toll Free: (888) 851-7967

 

 

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CANCELLATION POLICY: A minimum of 48 hours notice is required to cancel any reservation. A full refund will be paid on any reservation canceled prior to this minimum notice. In the event of dangerous weather or ocean conditions, we may cancel your tour, you may choose to transfer your activity to a later date or receive a full refund.

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