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?
• Diabetes?
• 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.