OK, This may be old questions about an old form, but I'm looking at a PADI one from 5-10 years ago.---
Seems on the left side there's a checklist of things to look at and check off. If you have or do any of these things you "must seek advice of your physician"......doesn't say you need a note from the doctor.
For me here, I would say YES to:
--occasionally smoking a pipe.
--take prescription medication--pills for my sensitive bladder.
--HAD severe hayfever or allergy (YES, but not since about age 35 and I'm 63)
Using common sense, I MAY not answer YES to any of those 3 (honestly can't recall what I've done with that it's been so long ago).
The right side specifically SAYS "answer YES....we must request that you consult with a physician".... and you can get such a form from your instructor, etc.
Now, all the stuff on THIS side looks really serious! And I'd WANT to ask a Dr.
I don't know what the left side means you should do with a YES--just see the Dr. for your own good and don't worry about telling the shop?
Again, it's an old form--apologize if it's changed.