PLEASE BE AWARE THIS IS A BOOKING REQUEST FORM. WE WILL CHECK AVAILABILITY AND GET BACK TO YOU DURING BUSINESS HOURS. IF YOU ARE BOOKING FOR THE NEXT 24 HOURS WE ADVISE CALLING TO +61 451 028 963. IF BOOKING FOR MORE THAN ONE PERSON, PLEASE MAKE SURE THAT EACH INDIVIDUAL HAS SEEN THE MEDICAL STATEMENT AND CONFIRMED THEIR INDIVIDUAL MEDICAL STATUS. PLEASE PLACE THE NAME OF EACH INDIVIDUAL JOINING IN THE MESSAGE BOX BELOW.
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Are all participants confident swimmers able to swim 200m unassisted? YesNo
Medical Questionnaire. Please read carefully through the following medical form. Please be aware that if you tick yes to any of the following you will need to get a dive medical to go diving. A certificate of clearance would need to be shown to the Instructor on the day. Do any participants in this booking suffer from or have they in the past suffered from any of the following conditions:
YesNo Asthma or wheezing YesNo Fainting, seizures or blackouts YesNo Chronic sinus condition YesNo Chest surgery YesNo Recurrent Ear problems when flying YesNo Epilepsy YesNo Diabetes Mellitus (Sugar Diabetes) YesNo Tubercolosis or long-term lung disease YesNo Brain, spinal cord or nervous disorder YesNo Heart disease of any kind YesNo Collapsed Lung YesNo Ear surgery
Do any of the persons in this booking currently suffer from :
YesNo Chronic Ear discharge or infection YesNo Breathlessness YesNo High Blood pressure YesNo Perforated eardrum YesNo Other illness or operation within the last month YesNo Are any of the persons taking any medicine or drug (excl. Oral contraceptives)? YesNo Are any of the persons in this booking pregnant? YesNo Are you planning to fly within 24 hours of completing your dive?
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