Scuba Diving Medicals: What Disqualifies You?

The medical questionnaire is the part of getting certified that quietly worries the most people. Here's what can rule you out of diving in Australia, what usually doesn't, and what happens if you answer "yes" to a question. It is general information about how the system works, not medical advice: decisions about your own fitness to dive belong with a doctor trained in diving medicine.

Why a medical even exists

Scuba diving puts your body through pressure changes that almost nothing else in everyday life does. At 10 metres you are breathing air at twice atmospheric pressure. At 30 metres, four times. Gas dissolves into your tissues on the way down, and has to come out in a controlled way on the way up. A condition that is mildly inconvenient on land, a head cold, a heart that skips, a lung scarred by an old infection, can become serious underwater.

The medical screen is not there to gatekeep. It is there to find the small number of conditions that genuinely make diving dangerous, and the larger number that need a specialist's clearance to dive safely. Many people answer "no" to every question and need no doctor at all. Others need a visit to a dive doctor, and a smaller number are advised against diving.

The honest framing: many things people privately worry about, such as being over 60, wearing glasses or contact lenses, or mild hearing loss, do not stop you diving on their own, and asthma can often be cleared after proper testing. The conditions that genuinely rule people out are uncommon and usually known to the person well before they walk into a dive shop.

The two-form system used in Australia

Australian dive shops use a layered system. You meet the first form. Many people never see the second.

Form 1: the Diver Medical Participant Questionnaire

This is the standard form handed to every student before an Open Water course. It replaced the old one-page RSTC (Recreational Scuba Training Council) medical statement in 2020, and the current version is dated 1 January 2026. It was written by the Diver Medical Screen Committee with the Undersea and Hyperbaric Medical Society (UHMS), DAN and others. Page one has 10 yes/no questions covering your heart, lungs and blood, age, fitness, eyes, ears, sinuses and teeth, surgery, the nervous system, mental health, back problems and diabetes, your stomach, and prescription medicines.

- All "no" answers: you sign the form and proceed. No doctor required. - A "yes" to three of the questions (struggling with moderate exercise, surgery in the past 12 months, or taking prescription medicine) means you need a doctor's evaluation before diving. - A "yes" to any of the other seven takes you to a box of follow-up questions on page two, and only a "yes" there means a doctor's visit. Being over 45, for example, only leads to questions about smoking, cholesterol, blood pressure and family history of early heart disease.

Form 2: the dive medical itself

If your questionnaire says so, or your dive shop asks for one, you book a dive medical. Some clinics and shops still call this an "AS 4005.1 medical", but Standards Australia lists AS 4005.1-2000 as withdrawn, and SPUMS (the South Pacific Underwater Medicine Society) says no current Australian and New Zealand standard covers recreational dive medicals. Many dive doctors use the SPUMS medical instead: the society's *Guidelines on Medical Risk Assessment for Recreational Diving*, now in its sixth edition (September 2025). It involves:

- A detailed medical history covering the conditions on the questionnaire and more. - A physical examination including your eyesight, your ears (the doctor watches your eardrums move as you gently equalise), heart, lungs, blood pressure and nervous system, with a balance test. - A lung function (spirometry) test, which SPUMS says is indicated for everyone having a diving medical. - A resting ECG for everyone aged 45 and over, plus a cardiovascular risk assessment. - A signed Statement of Health, which SPUMS says serves as your certificate of fitness to dive.

There is no single expiry date for a dive medical; see the section on cost, validity and Queensland below.

The doctor is not just ticking boxes, they are looking specifically at how a condition behaves at depth. A doctor with diving medicine training (more on finding one below) is trained to evaluate exactly this.

Conditions that usually rule diving out

Very few conditions rule out recreational diving for life, and the final call is always the dive doctor's. SPUMS guidance points to these as the most serious:

- A history of spontaneous pneumothorax (collapsed lung), a penetrating chest injury or open chest surgery. SPUMS lists all three among conditions that may carry an excessive risk of lung barotrauma, along with lung cysts (bullae) and fibrotic lung disease. A lung injury on ascent can be fatal, and SPUMS notes that serious lung overpressure injuries have happened in as little as 1 metre of water. - Chronic lung disease, such as COPD, emphysema, cystic fibrosis or pulmonary fibrosis. SPUMS flags any chronic lung disease, past or present, and any condition that could trap expanding gas in the lungs. - Epilepsy, fits or unexplained blackouts. SPUMS says anyone with a history of fits, including absence episodes, or unexplained blackouts should be strongly advised against diving; childhood febrile convulsions are the exception. For epilepsy after a head injury, SPUMS requires at least five years free of seizures and off medication before diving can be considered, and the UK Diving Medical Committee applies the same five-year rule to epilepsy generally. - Serious heart disease. SPUMS lists untreated or symptomatic coronary artery disease, heart failure, poor heart muscle function, hypertrophic cardiomyopathy, moderate to severe valve disease, complex congenital heart disease, pulmonary hypertension, an implanted defibrillator, recurrent fainting and arrhythmias that cause blackouts as usually making a person unsuitable for diving. Some become diveable after successful treatment. - Some ear conditions. SPUMS regards a previous stapedectomy (an operation on the tiny bones of the middle ear) as a contraindication, and strongly advises against diving if you cannot equalise your middle ears or your eardrums are not intact. - Pregnancy. The questionnaire says plainly: if you are pregnant, or attempting to become pregnant, do not dive. Diving can resume after the birth (see the pregnancy section).

If none of those apply to you, you are unlikely to be facing an outright no.

Conditional disqualifications, where most people land

These are the ones that get a "yes" on the form and then need a dive doctor's evaluation. Many are clearable.

- Asthma (see the dedicated section below). - Hypertension (high blood pressure). SPUMS says treated, well-controlled high blood pressure, without other risk factors that call for heart screening, is acceptable for diving. Blood pressure above 160/100 is a contraindication until it has been investigated and treated. - History of decompression illness. The SPUMS questionnaire asks about it. If a case turns out to involve a patent foramen ovale (PFO, see the heart section), divers are usually advised to stop diving, change how they dive or have it closed. - Migraines. SPUMS asks for further assessment, because migraine with aura is linked to a PFO, which raises the risk of neurological decompression illness, and frequent headaches can be confused with decompression illness. - Diabetes (see dedicated section). - Anxiety, depression or other mental health conditions. Assessed case by case (see the mental health section). - Ear surgery and grommets. While a grommet is in place your eardrum is not intact, which SPUMS says should lead to strong advice against diving. Middle ear surgery, including tympanoplasty, needs a diving specialist's and possibly an ENT specialist's opinion. - Hearing loss. SPUMS says hearing loss is not necessarily a contraindication; the doctor may order a hearing test as a baseline. - Reflux and stomach problems. SPUMS asks that candidates be free of significant stomach or bowel problems that could cause a sudden crisis, such as severe reflux or peptic ulcers, and the questionnaire asks about frequent heartburn or reflux. - Hernias. SPUMS notes that an abdominal hernia may risk gas trapping in the bowel and suggests considering repair; the questionnaire flags an uncorrected hernia that limits your activity. - Past back, neck or joint problems. The questionnaire flags back surgery in the past 12 months or recurrent back problems that limit everyday activity, and SPUMS points out that the weight of the gear out of the water can be a hazard for anyone with back or joint disease. - Vision, contact lenses and glasses. Rarely a barrier. SPUMS checks your eyesight with and without correction and advises against diving if the best vision in your better eye, or both eyes together, is worse than 6/12, the same line used for a conditional driver's licence in Australia. Contact lenses can be worn under a mask (SPUMS warns that non-permeable lenses risk corneal ulcers), and prescription mask lenses are widely available.

Asthma and diving, the most common worry

Asthma is the single most common condition that makes new divers anxious about the medical, partly because the rules used to be much stricter.

SPUMS explains why it matters underwater. Over-reactive airways can trap air on the ascent and raise the risk of lung barotrauma and gas embolism. Even well-controlled asthma can flare with exercise, inhaled salt water or the cold, dry air from a cylinder, and an attack is hard to manage at depth.

The current Australian approach (SPUMS):

- Anyone with asthma should have spirometry, ideally a full flow-volume test. - If you have had asthma in the last ten years, or have a wheeze or unexplained cough, but your spirometry is normal, SPUMS recommends a bronchial provocation test: a laboratory challenge, using exercise, dry air or a salty mist, that checks whether your airways overreact. - Diving is inadvisable if you fail that test, but you can be re-tested once treatment has your asthma under control. - If you are cleared and take asthma medication, SPUMS recommends a review every year, checking your peak flow twice a day on dive trips, and not diving if it is more than 10 per cent below your best or if you have any symptoms.

Well-controlled asthma, especially if it has been quiet for years, can often be cleared after testing. The asthma that does not clear is poorly controlled asthma, or airways that overreact on the provocation test.

Practical: If you have asthma, do not panic about the form. Book the dive medical, take your inhaler and any specialist letters with you, and let the dive doctor make a proper evaluation rather than guessing from the questionnaire.

Heart and circulation conditions

The heart questions on the medical form are extensive because cardiac events are a leading cause of diving deaths: SPUMS reports that 28 per cent of recreational diving fatalities have a cardiac event as the disabling injury.

Generally acceptable after assessment:

- Well-controlled high blood pressure (see above). - Atrial fibrillation, if the heart rate is controlled, there is no sign of reduced blood flow to the heart and exercise capacity is good. But SPUMS treats anticoagulants (blood thinners such as warfarin, dabigatran, rivaroxaban or apixaban) as a contraindication in themselves, and many people with AF take them. - Coronary artery disease that has been successfully treated with a stent or bypass, if tests show no ongoing ischaemia and your exercise capacity is good. The waiting period afterwards is set by your cardiologist and dive doctor. - A patent foramen ovale (PFO), a small hole between the heart's upper chambers that about 25 per cent of people have. SPUMS does not recommend routine testing for it. If it is found after a case of decompression sickness, divers are usually advised to stop diving, change how they dive or have it closed. - A pacemaker, which SPUMS says is not an absolute contraindication, although the underlying condition matters and the device must be able to work at depth; the manufacturer can usually confirm its pressure rating.

Generally not suitable (SPUMS):

- Untreated or symptomatic coronary artery disease, including angina. - Heart failure or poor heart muscle function, and hypertrophic cardiomyopathy. - Blood pressure above 160/100 until investigated and treated. - Moderate to severe valve disease and complex congenital heart disease. - An implanted cardiac defibrillator (ICD). - Arrhythmias that cause blackouts, and recurrent fainting.

Age and the cardiac question: SPUMS recommends that every diver or candidate aged 45 and over has a medical with a focus on the heart, preferably by a doctor with diving medicine training: a resting ECG plus a standard cardiovascular risk calculation. Lower-risk candidates can usually go ahead; higher-risk candidates may be sent for a coronary calcium score, a CT angiogram or a stress test. This is a precaution against silent heart disease, not a disqualification.

Ear, nose and throat issues

The ears and sinuses are where most divers experience their first real difficulty: DAN calls middle-ear barotrauma, or ear squeeze, the most common dive injury. The medical screens for things that turn ordinary equalising into serious barotrauma.

What the doctor checks: SPUMS asks dive doctors to confirm that both eardrums are intact and move when you gently equalise, which shows your Eustachian tubes are open. If you cannot equalise your ears at all, SPUMS says you should be strongly advised against diving, and an ENT referral may help.

Flagged on the questionnaire: ear disease or ear surgery, hearing loss or balance problems, recurrent sinusitis in the past 12 months, and sinus surgery in the past six months all send you to a doctor.

Conditional (SPUMS):

- Chronic or recurrent sinusitis, a cleft palate, or severe allergies affecting the nose and airways, which can raise the risk of barotrauma. - Chronic discharge from the outer or middle ear. - Previous middle ear surgery, including tympanoplasty: referral to a diving specialist and possibly an ENT.

Generally do not clear:

- A previous stapedectomy, which SPUMS regards as a contraindication. - An eardrum perforation or a grommet in place, until healed and assessed. - A persistent inability to equalise.

If you cannot equalise reliably on land (swallowing, or gently blowing against a pinched nose, should work for most people), get an ENT review before your dive medical; it can shortcut the process.

Diabetes

Diabetes used to rule people out of diving. Today SPUMS says some people with either insulin-treated or non-insulin-treated diabetes may be able to dive with an acceptable level of risk, using guidance based on a 2005 UHMS and DAN workshop and the Australian Diabetes Society's position statement. Its criteria for recreational dive training include:

- Aged 18 or over. - At least three months since starting diabetes tablets, or one year since starting insulin. - No hypoglycaemic episodes needing someone else's help for at least a year, and no hypoglycaemia unawareness. - An HbA1c of 9 per cent or less, measured within three months before the assessment and at each annual review. - No hospital admissions for diabetes complications for a year, and no known eye, kidney, nerve or major blood vessel complications. - A review by the doctor who manages your diabetes, and a diving medical, before you start and every year.

On dive days, the protocol SPUMS reproduces from DAN asks insulin-treated divers to reach a blood glucose of at least 8 mmol/L, stable or rising across three checks before the dive, to keep it no higher than 14 mmol/L, and to cancel diving for the day above 16 mmol/L. It also calls for dives of no more than an hour, no dives that need decompression stops, go deeper than 30 metres or enter an overhead environment, a buddy who knows the plan, and oral glucose carried on every dive.

Type 2 diabetes that is not treated with insulin carries a lower risk of hypoglycaemia, but SPUMS notes that complications such as heart disease can still rule diving out, so the same careful assessment applies.

The SPUMS guidelines set out the Australian approach, and a dive doctor will work through the criteria with you. It is no longer a closed door.

Pregnancy

Pregnancy rules out diving for its duration. SPUMS says the safety of diving while pregnant has not been established and the risks to the baby remain uncertain, so anyone who may be pregnant or is trying to become pregnant should be strongly advised not to dive; the questionnaire says the same. The advice is precautionary rather than based on direct evidence, which for obvious ethical reasons does not exist.

After the birth, DAN suggests waiting at least three to four weeks (21 days minimum) after an uncomplicated vaginal delivery, at least eight weeks after an uncomplicated caesarean, and about 12 weeks after complications that needed bed rest. DAN considers diving safe while breastfeeding, with extra care over hydration and no diving if the breasts are inflamed or infected.

If you are trying to conceive, the guidance is not to dive.

Mental health and medications

The mental health questions catch a lot of new divers off guard. They are not a screen for whether you have ever felt anxious or sad. SPUMS asks dive doctors to look for conditions that could affect judgement or decision-making underwater, and notes there is little evidence to base these decisions on, so they are made case by case, ideally with your regular doctor or treating team.

SPUMS suggests advising against diving for anyone who is:

- out of touch with reality, or paranoid with delusions and hallucinations; - severely depressed and suicidal; - suffering significant anxiety with panic attacks (panic is commonly associated with diving deaths).

Assessed individually: general anxiety, attention deficit and hyperactivity disorders, narcolepsy and other conditions, and especially any anxiety triggered by being underwater, which may be assessed after a first try in the water.

Medications: SPUMS says mood-altering medicines need careful consideration and caution when diving, but stopping them in order to dive may be unwise. Side effects such as sedation can worsen at depth or look like decompression illness, so they are weighed case by case.

The questionnaire asks about treatment for psychological problems, panic attacks or addiction in the past five years, and a "yes" leads to follow-up questions. Be honest on the form. Dive doctors are not there to judge, they are there to evaluate fitness, and an undisclosed condition that becomes relevant underwater is a much bigger problem than a disclosed one that gets cleared.

Recent surgery, injuries and infections

These are the temporary contraindications, the ones that usually just require waiting. The questionnaire sends anyone who has had surgery in the past 12 months, or has ongoing problems from an old operation, to a doctor.

Waiting times (always confirm with your surgeon and a dive doctor):

- Eye surgery: the questionnaire flags eye surgery in the past three months. Dive medicine sources give about two weeks after PRK laser surgery, after a final check (DAN); at least three months after radial keratotomy (DAN, UK Diving Medical Committee); about a month after modern small-incision cataract surgery (UK Diving Medical Committee, DAN Europe) but about three months after the older extracapsular technique (UK Diving Medical Committee). For LASIK neither DAN nor the UK committee gives a dive-specific figure; an ophthalmologist writing for the American Academy of Ophthalmology advises no swimming for at least two weeks, and your surgeon sets the date. - Ear surgery: see the ear section. A stapedectomy is generally a permanent bar, and a grommet rules out diving while it is in place. - Sinus surgery: flagged on the questionnaire if it was in the past six months. - Abdominal and chest surgery: wait until your surgeon clears you for full activity and a dive doctor has assessed you. Open chest surgery is one of the lung-risk flags in the SPUMS guidelines. - Dental work: the questionnaire flags anyone still healing from a dental procedure, and SPUMS warns that recent extractions can let air into the tissues. - Common cold, flu, sinus or ear infection: wait until fully recovered. DAN's advice is simple: do not dive when congested, because congestion can stop your ears equalising. - Gastroenteritis: the questionnaire flags recent diarrhoea and any dehydration that needed medical treatment in the past seven days. - Head injury or concussion: the questionnaire flags a head injury with loss of consciousness in the past five years, and SPUMS asks for a neurologist's assessment after a significant head injury.

What happens if you tick "yes"

The typical Australian process:

1. You complete the questionnaire, and an answer says you need a medical evaluation. 2. You take all three pages to a doctor, ideally one trained in diving medicine (see below), before your course starts. 3. The doctor takes a history and examines you (often using the SPUMS medical), and either: - signs the questionnaire's evaluation page, or a SPUMS Statement of Health, saying you are fit to dive, or - asks for more tests (specialist referral, spirometry, ECG, hearing test, ENT review), or - declines to clear you and explains why. 4. You give the dive shop the signed evaluation. UHMS notes that only that final page needs to go back, so the detail of your health history can stay between you and your doctor.

If you dispute a decision, SPUMS suggests seeing a specialist diving physician.

Finding a dive doctor in Australia

Not every GP is trained for this. SPUMS says doctors without training in diving medicine should not do diving medicals, and that anything abnormal should be referred to a doctor who has that training. Your options:

- A doctor on the SPUMS Diving Doctors List. SPUMS keeps a list searchable by suburb on its website, spums.au, which also shows the doctors who do children's and occupational medicals. - A hospital hyperbaric unit. Some run dive medical clinics: the Royal Adelaide Hospital's Hyperbaric Medicine Unit, for example, offers outpatient dive medicals for recreational, commercial and occupational divers. - Your dive centre, which can tell you which local doctors its students use.

The questionnaire itself asks only for a certified medical doctor, so in some cases any GP can sign it. But a doctor with diving medicine training understands exactly what the dive shop needs to see, and Queensland's code of practice prefers one with diving medicine experience.

Cost, validity and the Queensland question

Cost: prices vary with the tests included. Examples checked in October 2026: $165 at Sports Clinic NQ in Townsville (including spirometry and a hearing test), from $175 at Scuba World on the Sunshine Coast, $195 at South Steyne Medical Centre in Manly, and $437.75 at Healthcare on Collins in Melbourne (including an ECG and spirometry). Healthcare on Collins notes its fee is not rebatable through Medicare.

Validity: there is no single expiry date. The questionnaire has no built-in expiry, and UHMS says each organisation sets its own rule. Queensland's code of practice asks for a certificate issued within 90 days before the course starts, and SPUMS recommends a reassessment after any significant illness and at least every five years from age 45. Operators can set their own windows: Adelaide Scuba, for example, says a diving doctor's clearance lasts 12 months with it. Check when you book.

The Queensland question: Queensland is the one state with its own legal rules for dive operators, in the *Safety in Recreational Water Activities Regulation 2024*, in force since 1 August 2024. Until then, Queensland used its own triggers for a compulsory medical, including age over 45, body mass index, gender and waist measurement. The 2024 rules replaced them with the standard questionnaire: if your answers say you need a doctor, you cannot do your training dives until you hand the operator a medical certificate, which the code says should preferably come from a doctor experienced in diving medicine and be dated within 90 days of the course. In Cairns, Divers Den has students fill in the questionnaire and see a doctor only if they answer yes, and Pro Dive Cairns applies the 90-day window. Try dives on reef boats use a shorter WorkSafe Queensland declaration, and operators can add their own rules: Sunlover, for example, requires a doctor's clearance for every intro diver aged 65 and over.

What to do before your appointment

- Take all three pages of the questionnaire, plus any form your dive centre gave you. - Bring your medical history. Specialist letters, recent test results and any chest X-rays from the past five years (Healthcare on Collins asks for these). - List your current medications, including dose and how long you have been on each. Blood pressure medicines, asthma inhalers, antidepressants, the lot. - Sort it out early. Book the medical before you pay for flights or a reef course, so a referral for an extra test does not derail your plans. - Be honest. A dive doctor's job is to evaluate risk, not to gatekeep. Underplaying a condition is the worst possible strategy because the form becomes useless and so does the clearance.

A final word on risk and honesty

The medical screen is the only formal check you will get before strapping on a tank, and it relies entirely on the truthfulness of the form. Dive staff are not doctors and cannot give medical clearance, as PADI reminds students. Dive shops do not run blood tests. The system works because most people answer honestly and the small fraction who need a closer look get one.

The single biggest risk to a diver is not the condition they declared, it is the one they hid. If you are unsure whether something matters, tick "yes" and let the dive doctor decide. Worst case, you spend an hour with a specialist and get cleared. Best case, you find out about something that mattered before it became a problem at 18 metres.

Next steps

- If you have not yet decided whether scuba is for you, read Is Scuba Diving Right for Me? for the broader fit question, and How Fit Do You Need to Be to Scuba Dive? for the fitness side. - Once cleared, see What to Expect in the Theory Module for the academic component, What to Expect in Your Pool Sessions for the confined-water training, and What to Expect in Your Open Water Training Dives for the four certification dives. - Choosing a school? Read PADI vs SSI vs NAUI on agency differences.

Disclaimer: This article is general information about how the recreational dive medical process works in Australia. It is not medical advice. Diagnoses, clearances and any decisions about whether you can safely dive are the role of a qualified diving medicine physician, not a website.

Sources

- UHMS and Diver Medical Screen Committee: Diver Medical Participant Questionnaire, version 2026-01-01 (PDF) - UHMS: Recreational Diving Medical Screening System - UHMS: Recreational Diving Medical Screening System FAQs - PADI Pros: New medical screening system for divers - PADI: Discover Scuba Diving - SPUMS: The SPUMS diving medical, 6th edition 2025 (PDF) - SPUMS: SPUMS Full Medical - SPUMS: Diving Doctors List - Standards Australia Store: AS 4005.1-2000 - Queensland Legislation: Safety in Recreational Water Activities Regulation 2024 - WorkSafe Queensland: Recreational Diving, Recreational Technical Diving and Snorkelling Code of Practice 2024 (PDF, worksafe.qld.gov.au; the site blocks automated checks) - WorkSafe Queensland: Table of changes, Safety in Recreational Water Activities Regulation 2024 (PDF) (worksafe.qld.gov.au/__data/assets/pdf_file/0022/129712/table-of-changes-srwa-regulation-2024.pdf; the site blocks automated checks) - WorkSafe Queensland: Table of changes, Code of Practice 2024 (PDF) (worksafe.qld.gov.au/__data/assets/pdf_file/0028/129718/table-of-changes-dive-code-of-practice-2024.pdf; the site blocks automated checks) - WorkSafe Queensland: Medical declaration for non-certified diving (PDF) (worksafe.qld.gov.au/__data/assets/pdf_file/0015/130290/medical-declaration-for-non-certified-diving.pdf; the site blocks automated checks) - UK Diving Medical Committee: Epilepsy - UK Diving Medical Committee: Ophthalmological problems - DAN: High-Pressure Ophthalmology - DAN Europe: Cataract surgery and diving - American Academy of Ophthalmology: Will my flying and diving affect LASIK surgery healing? - DAN: Middle-Ear Barotrauma (MEBT) - DAN World, Alert Diver: PFO Concerns in Dive Injury Treatment - DAN: 6 Common Questions About Women's Health and Scuba Diving - Royal Adelaide Hospital: Hyperbaric Medicine Unit (rah.sa.gov.au/services-clinics/hyperbaric-medicine-unit; the site blocks automated checks) - Sports Clinic NQ: Dive Medicals - Scuba World: Dive Medicals - South Steyne Medical Centre: Dive Medicals Sydney - Healthcare on Collins: Diving Medicals - Adelaide Scuba: Try Dive (adelaidescuba.com.au/courses/try-dive/; the site blocks automated checks) - Divers Den: Four Day PADI Open Water Course - Pro Dive Cairns: FAQ - Sunlover Reef Cruises: Introductory Scuba Dive

Header photo: A person wearing a nose clip blows into a spirometer during a lung function test, the kind done at a dive medical, by Jmarchn, CC BY-SA 3.0, via Wikimedia Commons.