PADI Medical Statement
Please answer each of the questions on your past or present medical history with a YES or NO. (Y, N or Check marks can not be accepted.) If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving.
Sign and date the form at the bottom.
**NOTE (If participant is under 18, parent and/or guardian must also sign and date.)