Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters.

Details and information

This medical questionnaire is part of your registration with Punkfish Diving. Please complete it fully and honestly. We will match it to your registration using your name and date of birth.

Recreational scuba diving and freediving requires good physical and mental health. There are some medical conditions which can be hazardous while diving. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving (breathhold diving). This form is principally designed as an initial medical screen for new divers, but is also appropriate for those considering any diving activity. For your safety, and that of others who may dive with you, answer all questions honestly.

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

First and last name
Date of birth
Open date/time selector