The purpose of this medical questionnaire is to ensure that you are medically fit to dive. Should you have any existing conditions that could compromise your fitness to dive, you will need to consult with a diving medical specialist. A positive response means that there may be a preexisting condition that may affect your safety while diving. Please answer the following questions with a YES or NO. If you are not sure, answer YES. If any of these statements apply to you, we must request that you consult with a physician, preferably a Diving Medicine Specialist prior to participating in diving activities.
Within the 40 days immediately preceding the date of this Health Declaration Form, have you: