First Name
Last Name
Date of Birth
Gender
Phone Number
First Name
Last Name
Phone Number
Have you ever gone diving before?
Are you currently certified by a diving organization (e.g., PADI, SSI, NAUI)?
Do you have any experience with the following? (Check all that apply)
Open water diving
Night diving
Deep diving
Wreck diving
Cave diving
Drift diving
Underwater photography
Do you have any medical conditions that may affect your ability to dive safely?
Are you currently taking any medications?
Have you ever experienced any of the following? (Check all that apply)
Asthma
Heart conditions
Ear or sinus problems
Seizures or epilepsy
Diabetes
High blood pressure
Lung disease
Recent surgery
Motion sickness
Other:
Are you pregnant or suspect you may be pregnant?
Do you smoke?
Do you consume alcohol regularly?
Have you ever had issues with equalizing pressure in your ears?
Are you comfortable swimming in deep water?
How would you rate your overall fitness level?
Excelent
Good
Average
Poor
Do you exercise regularly?
Can you swim at least 200 meters without stopping?
Can you tread water for at least 10 minutes?
What type of diving are you interested in? (Check all that apply)
Scuba diving
Snorkeling
Free diving
Technical diving
Recreational diving
Other:
What is your preferred diving environment?
Tropical waters
Cold waters
Freshwater lakes/rivers
Ocean/sea
Other:
Are you interested in obtaining a diving certification?
Do you have any specific diving goals?
Underwater photography
Marine conservation
Exploration
Other:
Do you own any diving equipment?
Will you require rental equipment?
Do you have any fears or concerns about diving?
Are you traveling with a group or alone?
Group
Alone
Other:
Do you have any dietary restrictions or allergies we should be aware of?
Any other comments or special requests?
I confirm that the information provided above is accurate to the best of my knowledge.
I understand that diving involves inherent risks, and I am responsible for disclosing any medical conditions or concerns that may affect my safety.
Signature:
Inquiry Form Insights
Please remove this inquiry form insights section before publishing.
The Diving Inquiry Form is a comprehensive tool designed to gather essential information about a potential diving student. Its purpose is to ensure the safety, suitability, and enjoyment of the diving experience for the participant while allowing the diving instructor or organization to assess risks, provide appropriate guidance, and tailor the activity to the individual's needs. Below is an insight into the key sections of the form and their importance:
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation section before publishing.
The mandatory questions on a diving client intake form are those that are critical for safety, legal liability, and risk assessment. These questions help ensure the participant is medically and physically fit for diving, has the necessary experience, and understands the risks involved. Below are the essential mandatory questions that should never be omitted:
Why?
Why?
Why?
Why?
Why?