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AED class

Medical Wavier Form

IHMP International Hyperbaric Medical Programs, Division of ITDA Group International and the first aid training arm of ITDA-IHMP International Co. Ltd. Offer here our International guideline "Fit to Dive" Self-Certification wavier form. NOTE: In many Countries a "Fitness to Dive Medical" Certificate from a physician maybe required...

Health Declaration

Please fill out the following form
in order to participate in our scuba diving activity.

ihmp first aid

First name

Email

Last name

Todays Date?

Date of Birth

Have you ever suffered from blackouts or mental illness?

No

Yes

Are you suffering from or ever suffered from a medical condition, illness, or injury, affecting your heart or lungs?

No

Yes

Are you a smoker?

No

Yes

Can you swim for 30m/100ft without any breathing difficulties?

No

Yes

Do you drink more than 4 units of alcohol a day?

No

Yes

Do you consider yourself "Fit To Scuba Dive"?

No

Yes

Contact in case of Emergency, Name and Contact Number with country code

If you answered yes to any question, please elaborate

Write your full name here

I declare that the data I’ve provided is accurate & complete. I have read and completed the ITDA-IHMP Training Statement and I understand the risks.

Thanks for submitting!

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Phone

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Email: admin@diveitda.com

Phone: +34 693 009 636

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