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