Medical Statement with Two Fish Divers

Could you be pregnant, or are you attempting to become pregnant?

Are you presently taking prescription medications? (with the exception of birth control or anti-malarial)

Are you over 45 years of age and can answer YES to one or more of the following?

• currently smoke a pipe, cigars or cigarettes

• have a high cholesterol level

• have a family history of heart attack or stroke

• are currently receiving medical care

• high blood pressure

• diabetes mellitus, even if controlled by diet alone

Have you ever had or do you currently have…

• Asthma, or wheezing with breathing, or wheezing with exercise?

• Frequent or severe attacks of hayfever 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 (seasick, carsick, etc.)?

• Dysentery or dehydration requiring medical intervention?

• Any dive accidents or decompression sickness?

• Inability to perform moderate exercise (example: walk 1.6 km/one mile within 12 mins.)?

• Head injury with loss of consciousness in the past five years?

• Recurrent back problems?

• Back or spinal surgery?

• Diabetes?

• Back, arm or leg problems following surgery, injury or fracture?

• High blood pressure or take medicine to control blood pressure?

• Heart disease?

• Heart attack?

• Angina, heart surgery or blood vessel surgery? Sinus surgery?

• Ear disease or surgery, hearing loss or problems with balance?

• Recurrent ear problems?

• Bleeding or other blood disorders?

• Hernia?

• Ulcers or ulcer surgery ?

• A colostomy or ileostomy?

• Recreational drug use or treatment for, or alcoholism in the past 5 years?

If you can answer YES to any of the above questions, it DOES NOT necessarily disqualify you from diving but it DOES mean that there is a preexisting condition that may affect your safety while diving and that you must seek the advice of your doctor before starting your course with us.

If you can answer YES to any of the above questions then you should be examined by your doctor before you arrive for your course. If your doctor is happy that you are fit to dive (ie he/she considers that your preexisting condition will not affect your safety while diving), then please bring a letter/note from him saying that this is the case.