First Name
Last Name
Date of Birth
Phone Number
Mailing Address
City
State/Province
Postal/Zip Code
First Name
Last Name
Phone Number
Relationship
Are you a certified diver?
Certifying Agency:
PADI
SSI
NAUI
BSAC
Date of Certification:
Number of logged dives:
Date of last dive:
Have you dived in the past 12 months?
What type of diving experience do you have? (Check all that apply)
Recreational Diving
Technical Diving
Wreck Diving
Cave Diving
Night Diving
Deep Diving
Drift Diving
Underwater Photography/Videography
Other (Please specify):
Are you interested in any specific diving courses or certifications?
What type of diving environment are you most interested in? (Check all that apply)
Warm water/Tropical reefs
Cold water
Wrecks
Caves/Caverns
Marine life viewing
Photography/Videography
Other (Please specify):
Are you interested in guided dives or independent diving?
Guided
Independent (If certified)
What is your preferred dive depth range?
Are you interested in shore dives or boat dives?
Shore
Boat
Both
Do you have any specific dive sites you would like to visit?
Do you have your own diving equipment?
Do you have any experience with using enriched air nitrox?
Are you interested in diving with nitrox?
Please answer the following questions honestly and to the best of your knowledge. Your safety is our priority.
Do you have any current or past medical conditions that may affect your ability to dive safely? (e.g., heart conditions, lung conditions, ear problems, sinus problems, epilepsy, diabetes, high blood pressure, asthma, allergies, recent surgeries, etc.)
Are you currently taking any medications?
Do you smoke?
Do you consume alcohol regularly?
Are you pregnant or think you might be pregnant?
Do you have any physical limitations or disabilities that we should be aware of?
Have you ever experienced any problems while diving before?
I understand and acknowledge the risks associated with scuba diving and related activities.
I certify that the information I have provided on this form is true and accurate to the best of my knowledge.
I agree to release [Dive Center Name] and its staff from any liability for injuries or damages that may occur during my participation in diving activities.
Please let us know if you have any other questions, requests, or special needs.
Thank you for completing this form. We look forward to diving with you!
Inquiry Form Insights
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This diving inquiry form is designed to gather comprehensive information about potential divers to ensure their safety and tailor their diving experience. It's a crucial first step for any reputable dive operation. Here's a breakdown of its key aspects:
1. Personal Information: This section collects basic contact details for the diver and an emergency contact. This is essential for communication and in case of emergencies.
2. Diving Experience & Certification: This is arguably the most important section. It aims to understand the diver's skill level, experience, and recent activity. Questions about certification, number of dives, and date of last dive help the dive operator assess the diver's proficiency and determine if refresher courses or additional training might be necessary. Asking about specific diving experiences (wreck, cave, night, etc.) allows the operator to match divers with suitable dive sites and activities. It also identifies potential areas where the diver might need guidance or supervision.
3. Dive Preferences & Interests: This section focuses on the diver's desires and expectations. Understanding what kind of diving environment they prefer (warm water, cold water, wrecks, etc.), whether they prefer guided or independent diving, and their preferred depth range helps the operator plan dives that the diver will enjoy. Information about equipment needs allows the dive center to prepare rentals in advance. Asking about nitrox experience and interest helps the operator cater to divers who prefer or are interested in using enriched air.
4. Health & Fitness: This section is critical for safety. Scuba diving can be physically demanding, and certain medical conditions can pose serious risks. The questions about medical history, medications, smoking, alcohol consumption, pregnancy, and physical limitations are designed to identify potential health issues that might make diving unsafe. It's important to be upfront and honest in this section. Dive operators often require a medical statement from a doctor if a diver answers "yes" to any of the medical questions. This is not meant to be intrusive but to prioritize the diver's well-being. Questions about previous diving problems help the operator understand if the diver has had any negative experiences and take appropriate precautions.
5. Liability Release and Agreement: This section is standard practice for most adventure activities. It acknowledges the inherent risks associated with diving and releases the dive operator from liability for accidents or injuries that may occur, provided they are not due to negligence on the operator's part. This section is usually signed upon arrival at the dive center.
6. Additional Information/Requests: This section provides an opportunity for the diver to communicate any specific needs, questions, or requests that haven't been covered in the form. This could include dietary restrictions, special equipment requirements, or any other relevant information.
Overall Purpose: The primary purpose of this inquiry form is to gather enough information to ensure the diver's safety and to create a positive and enjoyable diving experience. It allows the dive operator to assess the diver's skills, experience, and health status, and to tailor the diving activities to their individual needs and preferences. It's a crucial tool for responsible dive operations.
Mandatory Questions Recommendation
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While the necessity of specific questions can depend on the dive operation's policies and local regulations, the following questions on this client intake form are generally considered mandatory for safety and operational reasons:
Section 1: Personal Information
Section 2: Diving Experience & Certification
Section 4: Health & Fitness
Why these are mandatory:
Important Considerations:
In summary, the mandatory questions focus on identifying the diver, assessing their qualifications and recent experience, and understanding their health status to ensure a safe diving experience for everyone involved.