DIVER MEDICAL
QUESTIOnNaire
DIVE FITNESS: THE MEDICAL QUESTIONNAIRE
Scuba diving requires physical and mental fitness to ensure safety underwater. Before participating in any dive program, all divers must complete the Diver Medical Questionnaire—a standardized form used worldwide to identify health conditions that may affect safe diving.
Completing the questionnaire is a vital step in protecting yourself and others, ensuring every dive is safe, supported, and medically responsible.
PAGE 1
General Health Questions
Read each question carefully.
Answer YES or NO honestly.
Personal Information Section
Sign to confirm your answers are truthful.
Add the current date
(DD/MM/YYYY format).Write your full legal name
(first and last).Add your date of birth
(DD/MM/YYYY format).
All NO’s - Your form is complete
YES Answers - Go to the corresponding box on Page 2 and select your answers.
PAGE 2
Personal Information Section
Write your full legal name
(first and last).Add your date of birth
(DD/MM/YYYY format).
Go to the corresponding box from Page 1 and select your answers on PAGE 2.
YES Answers
Questions 3, 5 or 10 on Page 1
OR any questions on Page 2
Take all three pages to your physician for a medical evaluation. Participation in a diving course requires your physician’s approval.
PAGE 3
Personal Information Section
Write your full legal name
(first and last).Add your date of birth
(DD/MM/YYYY format).
Evaluation Result Section
Must be completed by a physician
Approved or Not Approved checked
LIMITS or CONDITIONAL NOTATATIONS will invalidate the Physician’s Evaluation Form
HAVE QUESTIONS?
DAN Medical Information Line
+1 (919) 684-2948, Option 4
Monday – Friday, 8:30 AM to 5:00 PM ET
DIVE ASSURE Information Line
+1 (866) 898-0921
Monday - Friday 9:00 AM to 5:00 PM
