AN EXAMPLE OF THE UK SPORT DIVER MEDICAL FORM

Notes to divers

Exceptional fitness is not essential; both men and women can dive safely providing they are reasonably fit. Some diving can at times involve heavy physical exertion. Moreover, recreational diving in the UK is carried out in what can occasionally be a cold, dark and hostile environment and it entails responsibility for the safety of other divers. If you have any queries then please contact a medical referee.

Please read carefully

Divers answering "No" to all questions should be ok to start the training, Divers answering "Yes" to any question below or who are unsure on any area must seek advice from a Medical Referee, - From a telephone call enquiry, the Medical Referee may only need to endorse this form on your behalf or the Medical Referee may require to see you for examination, if you are found fit to dive, they will give you a completed Certificate of Fitness to Dive with an expiry date or a statement that further medical assessment is not required.

Diver Medical Health Questionnaire

1.  Have you ever suffered from heart diseases, circulation, high pressure, angina, chest pains or palpitations?

2.  Have you at any time had chest or heart surgery?

3.  Have you suffered from or had to take medication for asthma?

4.  Have you ever had collapsed lung or pneurnothorax?

5.  Have you ever had any other chest or lung disease?

6.  Have you suffered at any time from blackouts, fainting or recurrent dizziness?

7.  Have you had regular ear problems in the past ten years?

8.  Do you have an ileostomy, colostomy or ever had repair of a hiatus hernia?

9.  Have you ever had epilepsy or fits?

10. Have you had recurrent migraines?

11. Have you ever had any other disease of the brain or nervous system (including strokes or multiple sclerosis)?

12. Have you ever had any back or spinal surgery?

13. Have you any history of mental or psychological illness, fear of small spaces, crowds or panic attacks?

14. Have you any history of alcohol or drug abuse in the past five years?

15. Do you have diabetes?

16. Are you currently taking any prescribed medication (except the contraceptive pill)?

17. Are you currently receiving medical care or seen a doctor in the last year other than for trivial Infection?

18. Have you ever been refused a diving medical certificate or life Insurance or been offered special terms?

19. Have you ever had, or been treated for, decompression illness?

Remember,

answering "Yes" to any of the above question doesn't necessarily mean that you can't learn to dive, just that you must seek advice from a Medical Referee first, we can advise you who to see.

Note - All members of 'Stourport Divers' are required to gain & maintain a valid 'Doctors certificate of fitness to dive'.

To download the medical form right click the following and save the target Medical Self Cert