Richard’s form

Read the text and fill out the form below on behalf of Richard based on his health condition

Hi, my name is Richard, and I'm an aspiring diver. I don't have diabetes, but I was told by my doctor that my blood pressure is pretty high. I don't have any allergies. Neither do I have sinusitis or bronchitis, but I am prone to catching colds. I don't struggle to do exercise; I work out every day. I have never received a surgery. I have a huge fear of heights. I do not suffer from epilepsy, seizures, or convulsions. I do get small headaches when I work for too long, but they're nothing serious. I have never fainted or lost consciousness.



Have you ever had or do you currently have:

YES NO

Frequent issue with your blood pressure or diabetes?


Frequent or severe attacks of hayfever or allergy?


Frequent colds, sinusitis or bronchitis?


Frequent struggles with perfoming moderate exercise?


A surgery to any part of your body?


Behavioral health, mental or psychological problems (fear of closed or open space)?


Epilepsy, seizures, convulsions?


Recurring complicated migraine headaches?


Blackouts or fainting?

Part B (part bi)

Assess the results

In order to pass the medical exam, an aspiring diver needs to say "NO" to at least 6 questions on the form. Based on the results you previously filled out, do you think Richard is qualified to become a diver?

YES NO