marine conservation
PADI Medical Questionairre
Please check all that apply to you:
Are you presently taking prescription medications?
  (with the exception of birth control or anti-malarial)
Could you be pregnant, or are you attempting to become pregnant?
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)?
• Other chest disease or chest surgery?
• Behavioral health, mental or psychological problems
  (panic attack, fear of closed or open spaces, depression)?
• Epilepsy, seizures, convulsions or take medications to prevent them?
• Recurring migraine headaches or take medications to prevent them?
• Blackouts or fainting (full/partial loss of consciousness)?
• Frequent or severe suffering from motion sickness
  (seasick, carsick, etc.)?
• Dysentery or dehydration requiring medical intervention?
• Any dive accidents or decompression sickness?
• Inability to perform moderate exercise
  (example: walk 1.6 km/one mile within 12 mins.)?
• Head injury with loss of consciousness in the past five years?
• Recurrent back problems?
• Back or spinal surgery?
• Diabetes?
• Back, arm or leg problems following surgery, injury or fracture?
• High blood pressure or take medicine to control blood pressure?
• Heart disease?
• Heart attack?
• Angina, heart surgery or blood vessel surgery?
• Sinus surgery?
• Ear disease or surgery, hearing loss or problems with balance?
• Recurrent ear problems?
• Bleeding or other blood disorders?
• Hernia?
• Ulcers or ulcer surgery ?
• A colostomy or ileostomy?
• Recreational drug use or alcoholism in the past five years?