PADI DISCOVER SCUBA DIVING COURSE: MEDICAL DECLARATION
(as appears on the Discover Scuba Diving form, which you must complete and sign before starting the course):

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.

Have you suffered from, or do you now suffer from, any of the following:

Are you currently suffering from:

    Asthma or wheezing?

    Breathlessness?

    Fainting, seizures or blackouts?

    Chronic Ear Discharge or infection?

    Chronic Bronchitis or persistent chest complaints?

    High Blood Pressure?

    Chronic sinus conditions?

    Perforated Eardrum?

    Chest surgery?

    Other illness or operation within the last month?

    Recurrent ear problems when flying?

    Are you currently taking any medicine or drug (excluding oral contraceptives)?

    Epilepsy?

    Have you ingested any alcohol within the last 8 hours prior to diving?

    Diabetes Mellitus? (sugar diabetes)

    Are you pregnant?

    Tuberculosis or other long-term lung disease?

    Brain, spinal cord or nervous disorder?

    Heart disease of any kind?

    Collapsed lung (pneumothorax)?

    Ear surgery?

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

    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)?