Recreational scuba and freediving students complete the Diver Medical Participant Questionnaire before training, and certain yes answers mean a physician must evaluate them first. The third page, the Medical Examiner's Evaluation Form, records whether the examiner finds conditions incompatible with diving, and the diver takes the signed page back to the instructor or dive facility.
The participant answers ten questions and any follow-up boxes, then signs (a parent or guardian signs for a minor). A certified medical doctor or other legally certified medical provider completes the evaluation page: approved or not approved, signature, credentials, clinic details and an optional stamp.
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Diver Medical | Participant Questionnaire and Evaluation Form
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The signature line reads certified medical doctor or other legally certified medical provider. The examiner prints their name and clinical degrees or credentials, adds clinic or hospital and contact details, and may stamp the form. The result is a simple approved or not approved.
When the participant answers yes to question 3, 5 or 10 on page 1, or to any question in boxes A through G on page 2, such as heart surgery, asthma limiting exercise, recent sinus or eye surgery, seizures or diabetes. Otherwise the participant signs the statement and no evaluation is required.
Yes. UHMS hosts a Spanish version of form 10346 alongside the English one, and the questionnaire is published in roughly 30 languages, including Arabic, Chinese, French, German, Japanese, Korean, Portuguese and Tagalog.