Diver Medical Questionnaire

How to complete the questionnaire

1. Download and open the complete three-page PDF.
2. Read every question carefully and answer honestly.
3. Sign and date the participant statement where indicated.
4. If the form directs you to obtain medical clearance, take all three pages to a physician.
5. Bring the completed form and any required physician approval for your dive activity.

Download the 3-page PDF

When is a physician's approval required?

If you answer NO to all 10 questions on page 1, the form states that a medical evaluation is not required; you still need to sign and date the participant statement.

If you answer YES to questions 3, 5 or 10 on page 1, or YES to any question on page 2, the form requires a medical evaluation and physician's approval before participating in a diving course.

Important safety notes

• If you are pregnant or attempting to become pregnant, do not dive.
• If you feel ill or believe you may have a contagious disease, do not participate in diving activities.
• If you have concerns about your fitness to dive that are not covered by the form, consult a physician before diving.
• A parent or guardian must sign for a minor participant.
• Ultra Marine Divers may request medical clearance whenever a health or safety concern requires it.

Your medical information stays private

The website does not ask you to enter or submit your medical answers online. Download the form and complete it privately. Please do not send unnecessary medical documents through the public contact form.

If you are unsure what is required, contact us before your dive and we will explain the next step without asking you to publish sensitive details on the website.