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The Oahu Scuba Diving And Certification Specialists
Sean@reefpirates.com Oahu - Hawaii - Waikiki - Honolulu (808)348-2700
Copyright 2006 - Reef Pirates
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Questionnaire:
Could you be pregnant or are you attempting to become pregnant?
Do you regularly take prescription or non-prescription medications? (with the exception of birth control)
Are you over 45 years of age and have one or more of the following:
1.currently smoke a pipe, cigars or cigarettes?
2.have a high cholesterol level?
3.have a family history of heart attacks or strokes?
Have you ever had or do you currently have any of the following?
Asthma, or wheezing with breathing, or wheezing with exercise?
Frequent or severe attacks of hay fever or allergy?
Frequent colds, sinusitis or bronchitis?
Any form of lung disease?
Pneumothorax (collapsed lung?)
History of chest surgery?
Claustrophobia or agora phobia (fear of closed or open spaces)?
Behavioral health problems?
Epilepsy, seizures, convulsions or do you take medications to prevent them?
Recurring migraine headaches or do you take medications to prevent them?
History of blackouts or fainting (full or partial loss of consciousness)?
Do you frequently suffer from motion sickness (seasick, carsick, etc.?)
History of diving accidents or decompression sickness?
History of recurrent back problems?
History of back surgery?
History of diabetes?
History of back, arm or leg problems following surgery, injury or fracture?
Inability to perform moderate exercise (example: walking one mile within 12 minutes)?
History or high blood pressure or do you take medication to control blood pressure?
History of any heart disease?
History of heart attacks?
Angina or heart surgery or blood vessel surgery?
History of ear or sinus surgery?
History of ear disease, hearing loss or problems with balance?
History of problems equalizing (popping) ears with airplane or mountain travel?
History of bleeding or other blood disorders?
History of any type of hernia?
History of ulcers or ulcer surgery?
History of colostomy?
History of drug or alcohol abuse?
Could you be pregnant or are you attempting to become pregnant?
Do you regularly take prescription or non-prescription medications? (with the exception of birth control)
Are you over 45 years of age and have one or more of the following:
1.currently smoke a pipe, cigars or cigarettes?
2.have a high cholesterol level?
3.have a family history of heart attacks or strokes?
Have you ever had or do you currently have any of the following?
Asthma, or wheezing with breathing, or wheezing with exercise?
Frequent or severe attacks of hay fever or allergy?
Frequent colds, sinusitis or bronchitis?
Any form of lung disease?
Pneumothorax (collapsed lung?)
History of chest surgery?
Claustrophobia or agora phobia (fear of closed or open spaces)?
Behavioral health problems?
Epilepsy, seizures, convulsions or do you take medications to prevent them?
Recurring migraine headaches or do you take medications to prevent them?
History of blackouts or fainting (full or partial loss of consciousness)?
Do you frequently suffer from motion sickness (seasick, carsick, etc.?)
History of diving accidents or decompression sickness?
History of recurrent back problems?
History of back surgery?
History of diabetes?
History of back, arm or leg problems following surgery, injury or fracture?
Inability to perform moderate exercise (example: walking one mile within 12 minutes)?
History or high blood pressure or do you take medication to control blood pressure?
History of any heart disease?
History of heart attacks?
Angina or heart surgery or blood vessel surgery?
History of ear or sinus surgery?
History of ear disease, hearing loss or problems with balance?
History of problems equalizing (popping) ears with airplane or mountain travel?
History of bleeding or other blood disorders?
History of any type of hernia?
History of ulcers or ulcer surgery?
History of colostomy?
History of drug or alcohol abuse?
Before starting an open water certification course or joining us for one of our discover scuba dives, you will need to complete a medical questionnaire. We have a provided a copy of the questionnaire below. Please note, that if you answer YES to any of the questions below, we would need a release from your doctor stating that you are medically fit for diving. If you are able to answer NO to all the questions, no release form is needed. Please feel free to email us or call us directly at (808) 348-2700 if you have any questions.