PADI Continuing Education Administrative Document
On the Medical Statement: Please answer the questions on your past or present medical history with a YES or NO. (Y, Nor Check marks can not be accepted) If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving.
There is three lines that you need to print your name.
Sign and date the form at the end. (If you are under 18, a parent or guardian must also sign and date.)