Diver's Medical Questionnaire

Your data, only yours.

¿Do you find this page a little weird?
That's because you are in an isolated enviroment: no trackers, no personalization profiles, no market research... notice there aren't even cookies warnings (because neither are cookies here).

¿But why is that?
Medical Data is part of "Specially Protected Data" according to General Data Protection Regulation (GDPR) and it's spanish equivalent. So, we take this measures to ensure your data does not leave your device.

Since the publishing of Spain's Recreational Diving Safety Royal Decree (July 2020), all divers are obliged to sign and carry with them Annex 1, which is nothing more than a form, with questions about your health condition. Depending on your answers, the form's instructions will determine if you can just go diving, or if you will need a physician's approval first.
We'll not tell any lies. It isn't much fun.

So we took an effort to make it easier for you.

Just follow this steps:

Fill the form below.
Sign it and generate it. It will download to your device (and can be used to dive all across Spain).
You don't need to send us the questionnaire once completed. The system will report to us if you are approved or not.
Come to dive ;)

Only a couple of warnings:

Ali Sub will not store nor process any medical data you input. All the processing takes place on your device.
Based in Recreational Diving Safety Royal Decree (550/2020, 2nd of July) we will log (only) if you are in possesion of a valid Diver's Medical Questionnaire, or not.
Please do not reload the page while you fill the form.

Take a deep breath, and… go for it!

Date of birth:

Note to women: If you are pregnant, or attempting to become pregnant, do not dive.

Recreational scuba diving and freediving requires good physical and mental health. There are a few medical conditions which can be hazardous while diving, listed below. Those who have, or are predisposed to, any of these conditions, should be evaluated by a physician. This Diver Medical Participant Questionnaire provides a basis to determine if you should seek out that evaluation. If you have any concerns about your diving fitness not represented on this form, consult with your physician before diving. If you are feeling ill, avoid diving. If you think you may have a contagious disease, protect yourself and others by not participating in dive training and/or dive activities. References to “diving” on this form encompass both recreational scuba diving and freediving. This form is principally designed as an initial medical screen for new divers, but is also appropriate for divers taking continuing education. For your safety, and that of others who may dive with you, answer all questions honestly.

1 - I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19

Yes No

1.1 - Chest surgery, heart surgery, heart valve surgery, stent placement, or a pneumothorax (collapsed lung)

Yes No

1.2 - Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise

Yes No

1.3 - A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition

Yes No

1.4 - Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

3 - I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to ftness or health reasons within the past 12 months

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

4 - I have had problems with my eyes, ears, or nasal passages/sinuses

Yes No

4.1 - Sinus surgery within the last 6 months

Yes No

4.2 - Ear disease or ear surgery, hearing loss, or problems with balance

Yes No

4.3 - Recurrent sinusitis within the past 12 months

Yes No

4.4 - Eye surgery within the past 3 months

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

5 - I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

6 - I have lost consciousness, had migraine headaches, seizures, stroke, signifcant head injury, or suffer from persistent neurologic injury or disease

Yes No

6.1 - Head injury with loss of consciousness within the past 5 years

Yes No

6.2 - Persistent neurologic injury or disease

Yes No

6.3 - Recurring migraine headaches within the past 12 months, or take medications to prevent them

Yes No

6.4 - Blackouts or fainting (full/partial loss of consciousness) within the last 5 years

Yes No

6.5 - Epilepsy, seizures, or convulsions, OR take medications to prevent them

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

7 - I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability

Yes No

7.1 - Behavioral health, mental or psychological problems requiring medical/psychiatric treatment

Yes No

7.2 - Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment

Yes No

7.3 - Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care

Yes No

7.4 - An addiction to drugs or alcohol requiring treatment within the last 5 years

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

8 - I have had back problems, hernia, ulcers, or diabetes

Yes No

8.1 - Recurrent back problems in the last 6 months that limit my everyday activity

Yes No

8.2 - Back or spinal surgery within the last 12 months

Yes No

8.3 - Diabetes, drug- or diet-controlled, OR gestational diabetes within the last 12 months

Yes No

8.4 - An uncorrected hernia that limits my physical abilities

Yes No

8.5 - Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

9 - I have had stomach or intestine problems, including recent diarrhea

Yes No

9.1 - Ostomy surgery and do not have medical clearance to swim or engage in physical activity

Yes No

9.2 - Dehydration requiring medical intervention within the last 7 days

Yes No

9.3 - Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months

Yes No

9.4 - Frequent heartburn, regurgitation, or gastroesophageal refux disease (GERD)

Yes No

9.5 - Active or uncontrolled ulcerative colitis or Crohn’s disease.

Yes No

9.6 - Bariatric surgery within the last 12 months

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

10 - I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefoquine/Lariam)

Yes No

Oops... This combination of answers requires you to obtain a physician's approval before you can dive. Details are available at form's end ;)

Sign here:
(Must be your guardian's signature if you are under 18 years old)

Participant Statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.

I confirm that I have read and accept the processing of my personal data and the privacy policy of Ali Sub.

I accept that, in the event of not submitting the Diver's Medical Questionnaire along with the Physician's Evaluation Form (filled) on dive's day I WILL NOT be able to take part in the activity (for making things easier, you will find attached on page 3 the Physician's Evaluation Form already filled with your data).