Please answer the following questions on your past or present medical history with a YES or NO answer. If you are not sure, choose YES.
If any of these conditions apply to you, we must request that you consult with a physician prior to participating in a scuba diving program or any marine sports program that we offer.
*For safety reasons, we must check your blood pressure if you are 60 years old and above on the day of the event. If it is higher than 170, you will not be able to join our the diving trips. If your blood pressure exceeds 160 but is lower than 170, you will need to sign a waiver to participate in our tours.
Does any of the following apply to you?
- Could you be pregnant, or are you attempting to become pregnant?
(For safety reasons we cannot let you join an activity or board a ship if you might be with child.)
- Are you presently taking any medications? (Other than birth control pills or antimalarial medication)
- 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)?
- 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 or 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 history?
- 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?
If you have any positive answers to any of the questions above：
▲ Please inform our reservation center at firstname.lastname@example.org when you book with us. A positive response means that there is a pre-existing condition that may compromise your safety when diving and you must seek advice from your physician prior to engaging in any diving activities. Note that failing to disclose such information upon booking automatically releases Seasir of all responsibility in case of any accident occurring during our tours.
▲ We must request that you consult with a physician and issue a medical certification by physician before join this tour/course.
Here is steps：
・Step ① Please click and download the “MEDICAL STATEMENT“, please read and agree to the statement above by signing and dating it.
・Step ② Take all three pages of this form to a clinic/hospital to your physician for a medical evaluation. Participation in a diving course requires your physician’s approval.
・Step ③ Please send it to our reservation center at email@example.com before your tour/course date by email.