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 activities or Certification Course Programs..

First name

Your E-mail

Date of Birth

Todays Date?

Country

Last name

Certification Course

Instructor Name or Training Facility Name

Instructor Name or Training Facility E-mail address

Have you ever suffered from blackouts or mental illness?

Yes

Do you get or beome out of breath from moderate exercse?

Yes

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

Yes

Are you a smoker?

Yes

Do you engage in any sports?

Yes

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

Yes

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

Yes

Would you describe yourself as a "Fit & Healthy" person?

Yes

Do you consider yourself "Overweight" for your height / age or BMI Index?

Yes

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

If you answered yes to any question, please elaborate / explain.

Add any additional Information

Write your full name here

I declare that the data I have provided is accurate & complete, to the best of my knoweldge.. I have read and completed the ITDA-IHMP Training Statement and I understand the risks. BOX MUST BE CHECKED TO ACCEPT FORM

Thanks for submitting!

Link to Training Statement