1. Do you currently have an ear infection?
2. Do you have a history of ear disease, hearing loss or problems with balance?
3. Do you have a history of ear or sinus surgery?
4. Are you currently suffering from a cold, congestion, sinusitis or bronchitis?
5. Do you have a history of respiratory problems, severe attack of hayfever or allergies, or lung disease?
6. Have you had a collapsed lung (pneumothorax) or history of chest surgery?
7. Do you have active asthma or history of emphysema or tuberculosis?
8. Are you currently taking medication that carries a warning about any impairment of your physical or mental abilities?
9. Do you have behavioral health problems or a nervous system disorder?
10. Are you or could you be pregnant?
11. Do you have a history of colostomy?
12. Do you have a history of heart disease or heart attack, heart surgery or blood vessel surgery?
13. Do you have a history of high blood pressure, angina, or take medication to control blood pressure
14. Are you over 45 and have a family history of heart attack or stroke?
15. Do you have a history of bleeding or other blood disorders?
16. Do you have a history of diabetes?
17. Do you have a history of seizures, blackouts or fainting, convulsions or epilepsy or take medications to prevent them?
18. Do you have a history of back, arm or leg problems following an injury, fracture or surgery?
19. Do you have a history of fear of closed or open spaces or panic attacks (claustrophobia or agoraphobia)?

A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of a physician. If any of these items apply to you, consult with a physician prior to participating in scuba diving.