Post-Dive Flight Fitness Form
Please complete this form to assess your fitness to fly after diving. All fields are required for post-dive flight safety evaluation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Last Dive
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Number of Dives Completed in Last 24 Hours
*
Maximum Depth Reached (meters)
*
Surface Interval Before Flight (hours)
*
Flight Departure Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Were any decompression stops required during your dives?
*
Yes
No
Since your last dive, have you experienced any of the following symptoms? (Select all that apply)
*
Pain
Dizziness
Shortness of breath
Unusual fatigue
None of the above
Did you seek medical evaluation for any symptoms after diving?
*
Yes
No
Submit
Should be Empty: