Dear Adamk119
First I would like to say hope u will get well soon..
Listen dear in any organization if u want to take a course with then what ever was the course u have to sign a medical statement ,
In this message u have an example of one so u can have an Idea about , if u answered yes to one of these u should go to the doctor and let him check u and bring back with u a paper that u r able to dive
.
So anyway u have to see a doctor to make sure that if u did a course u wont be hurt more or u wont have any problems
MEDICAL HISTORY
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
preexisting 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 and Guidelines for Recreational Scuba Divers Physical Examination to take to your physician.
_____ Could you be pregnant or are you attempting to become pregnant?
_____ Do you regularly take prescription or nonprescription medications?
(with the exception of birth control)
_____ 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 . . .
_____ 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)?
_____ History of chest surgery?
_____ Claustrophobia or agoraphobia (fear of closed or open spaces)?
_____ Behavioral health problems?
_____ Epilepsy, seizures, convulsions or take medications to prevent them?
_____ Recurring migraine headaches or take medications to prevent them?
_____ History of blackouts or fainting (full/partial loss of consciousness)?
_____ Do you frequently suffer from motion sickness (seasick, carsick, etc.)?
_____ History of diving accidents or decompression sickness?
_____ History of recurrent back problems?
_____ History of back surgery?
_____ History of diabetes?
_____ History of back, arm or leg problems following surgery, injury or fracture?
_____ Inability to perform moderate exercise (example: walk one mile within 12 minutes)?
_____ History of high blood pressure or take medicine to control blood pressure?
_____ History of any heart disease?
_____ History of heart attacks?
_____ Angina or heart surgery or blood vessel surgery?
_____ History of ear or sinus surgery?
_____ History of ear disease, hearing loss or problems with balance?
_____ History of problems equalizing (popping) ears with airplane or mountain travel?
_____ History of bleeding or other blood disorders?
_____ History of any type of hernia?
_____ History of ulcers or ulcer surgery?
_____ History of colostomy?
_____ History of drug or alcohol abuse?
Please read carefully before signing.
This is a statement in which you are informed of some potential risks
involved in scuba diving and of the conduct required of you during the
scuba training program. Your signature on this statement is required
for you to participate in the scuba training program offered
by _________________________________________ and
Instructor
_______________________________________ located in the
Facility
city of __________________ and state of ____________.
Read and discuss this statement prior to signing it. You must
complete this Medical Statement, which includes the medical-history
section, to enroll in the scuba-training program. If you are
a minor, you must have this Statement signed by a parent.
Diving is an exciting and demanding activity. When per-formed
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. Diving can be strenuous under certain
conditions. 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 equalization 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
instructor before signing.
The information I have provided about my medical history is accurate to the best of my knowledge.
_______________________________________________________________________________________ __________________
Participants Signature Date (day/month/year)
_______________________________________________________________________________________ __________________
Signatures of Parent or Guardian (where applicable) Date (day/month/year)
