PADI: MEDICAL DECLARATION (as appears on PADI Student Record File, which you must complete and sign before starting any PADI course): Please use this as a Medical guideline for any Aqualogy course.

This is a statement in which you are informed of some of the potential risks involved in scuba diving and of the conduct required of you during the scuba training program.

Diving is an exciting activity. It can also be physically demanding. When performed correctly, applying correct techniques, it is very safe. When established safety procedures are not followed, however, there are dangers. To scuba dive safely, you must not be extremely overweight or out of condition. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with heart trouble, a current cold or congestion, epilepsy, asthma, a severe medical problem, or who is under the influence of alcohol or drugs should not dive. If taking medication, consult your doctor and the instructor before participation in this program. You will also need to learn from the instructor the important safety rules regarding breathing and equalisation while scuba diving. Improper use of scuba equipment can result in serious injury. You must be thoroughly instructed in its use under direct supervision of a qualified instructor to use it safely.
If you have any additional questions regarding this Medical Statement or the Medical History section, review them with your physician before signing.

MEDICAL HISTORY (as appears on the Student Record File, which you must complete and sign before starting a PADI course):

To the Participant:
The purpose of this medical questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a pre-existing condition that may affect your safety while diving and you must seek the advice of your physician.
Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with a PADI Medical Statement & Guidelines for Recreational Scuba Diver’s Physical Examination to take to your physician.

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

c Do you regularly take prescription or non-prescription medications? (with the exception of birth control)

c Are you over 45 years of age and have one or more of the following?

* currently smoke a pipe, cigars or cigarettes
* have a high cholesterol level
* have a family history of heart attacks or strokes

Have you ever had or do you currently have…:

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

c Frequent or severe attacks of hayfever or allergy?

c Frequent colds, sinusitis or bronchitis?

c Any form of lung disease?

c Pneumothorax (collapsed lung)?

c History of chest surgery?

c Claustrophobia or agoraphobia (fear of closed or open spaces)?

c Behavioural health problems?

c Epilepsy, seizures, convulsions or take medication to prevent them?

c Recurring migraine headaches or take medication to prevent them?

c History of blackouts or fainting (full/partial loss of consciousness)?

c Do you frequently suffer from motion sickness (seasick, carsick etc.)?

c History of diving accidents or decompression sickness?

c History of recurrent back problems?

c History of back surgery?

c History of diabetes?

c History of back, arm or leg problems following surgery, injury or fracture?

c Inability to perform moderate exercise (walk one mile within 12 minutes)?

c History of high blood pressure or take medication to control blood pressure?

c History of heart disease?

c History of heart attacks?

c Angina or heart or blood vessel surgery?

c History of ear or sinus surgery?

c History of ear disease, hearing loss or problems with balance?

c History of problems equalising (popping) ears with airplane or mountain travel?

c History of bleeding or other blood disorders?

c History of any type of hernia?

c History of ulcers or ulcer surgery?

c History of colostomy?

c History of drug or alcohol abuse?

c Do you understand that any concealment of any condition incompatible with safe diving might put your health or life at risk?

c Do you understand that you should not go to altitude (fly) within 12 hours of completing a single dive or 18 hours when doing multiple dives (where possible wait 24 hours)?