HEALTH CHECK LIST
Please check the following questions on your past or present medical history with a YES or NO answer. If you are not sure, answer YES. If any of these questions apply to you, we must request that you consult with a physician prior to participating in scuba diving program or any marine sports program that we offer.
- Could you be pregnant, or are you attempting to become pregnant?
- Are you presently taking any medications? (With the exception of Birth control or anti-malarial)
- Asthma, infantile asthma, or wheezing with breathing, or wheezing with exercise?
- Frequent or severe attacks of hay fever or allergy?
- Frequent colds, sinusitis or bronchitis?
- 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?
- Dysentery or dehydration requiring medical intervention?
- Any dive accidents or decompression sickness?
- Head injury with loss of consciousness in the past five years?
- Recurrent back problems?
- Back or spinal surgery?
- Back, arm or leg problems following surgery, injury or fracture?
- High blood pressure or take medicine to control blood pressure?
- Heart disease or Heart attack?
- Angina, heart surgery or blood vessel surgery?
- Sinus or any Body air space surgery?
- Bleeding or other blood disorders?
- Recreational drug use or treatment for, or alcoholism in the past five years?
- Hyperventilation syndrome?
- Do you use full dentures?
Please do inform us if there is any question above answers apply YES to you.
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