To qualify for scuba diving, all divers, including adaptive divers and adaptive buddies, must pass a medical clearance. Most importantly the medical issues we are concerned about include cardio-respiratory health and the taking of prescribed drugs.

You may still be able to dive with these medical conditions, and as a result, you must have your Medical Doctor (MD) or Doctor of Osteopathy (DO) sign and date the form releasing you before we can begin the program.

Diver Medical’s are valid for 12 months, therefore depending on when you enter our program and how long the training takes, we may need you to renew the Diver Medical and Physician’s Evaluation Form to complete the trip element of the program.

In addition, we may also ask for the same medical form to be filled out by any specialists you are seeing for specific medical issues (i.e. cardiologist, neurologist, etc.)

Medical Statement and Physician’s Evaluation Form

  • The portion of the medical statement regarding your instructor, their facility, and the facility’s location will be completed once we have the details of your training confirmed.
  • For your safety, we do not accept applications from candidates who have a subcutaneous pump for pain management, muscle spasms, or implanted devices that are contraindicated because of the risk of rupture during the dive.
  • We also do not accept candidates with ventriculoperitoneal (VP) shunts as they pose a risk for reverse fluid pressure during the dive.

The MDs or DOs sign-off

  • The purpose of the diver medical is to find out your current medical condition before participating in an adaptive diver program.
  • Guidelines for recreational adaptive scuba diver physical examination are available to your physician for clarification.
  • This signature must be made by an MD or DO. Unfortunately in this instance, a Physician’s Assistant (PA), Nurse Practitioner (NP), Family Nurse Practitioner (FNP), Family Nurse Practitioner Board Certified (FNP-BC), Certified Family Nurse PractitionerFNP-C, or aBachelor of Medicine and Bachelor of Surgery (MBBS) is NOT valid.

Before leaving your doctor’s office, check the following:

Physician’s Evaluation Form Checklist

  • Signed by an MD or DO.
  • Clearly dated.
  • Approval is unconditional (no comments, caveats, or restrictions).

Tip: Screenshot this page, and refer to it when you see your doctor to make sure nothing is missed.

Please scan and email all three pages to susan@divepirates.org or fax them to 832-694-4029

Because the Dive Pirates’ toll-free phone number may show up as spam, please add
877-393-3483 to your contacts so you’ll know it’s us calling to work out the details of your training.

If you have any questions, call us at 877-EYE-DIVE (877-393-3483) or email pirates@divepirates.org.

 

Print and Provide this form to your Physician