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Medical screening questionnaire 2025

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The document is a Diver/BUD/S Medical Screening Questionnaire from the U.S. Coast Guard, designed to assess the medical fitness of personnel for diving duties. It includes a series of medical questions regarding past health issues, physical conditions, and necessary medical evaluations. The questionnaire emphasizes the importance of full disclosure of medical history and outlines procedures for submitting completed forms to relevant authorities for approval.

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Click ‘Get Form’ to open the medical screening questionnaire in the editor.
Begin by entering your personal information at the top of the form, including your Name/Rank, EmplID, DOB, Present Command, and Branch of Service. This ensures that your responses are accurately linked to your identity.
Proceed to the Diving Medical Questions section. Carefully read each question and select 'Yes' or 'No' based on your medical history. If you answer 'Yes' to any question, be prepared to provide additional details as required.
Continue filling out the Additional Diving Medical Questions section. Ensure that all fields are completed accurately, especially those requiring confirmation from a Diving Medical Officer (DMO).
Once all sections are filled out, review your answers for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (21 Votes)
2010	4.4 Satisfied (80 Votes)

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What are screening questionnaires?

A screening question filters out respondents whose responses are relatively less valuable while helping you receive responses from those you value most.

What does a health screening questionnaire look like?

The survey consists of four sections, including personal information, lifestyle, medical history, and mental health. The questionnaire includes a mix of answer types, such as multiple choice and select-all-that-apply, and is split into different sections for ease of completion.

What does a medical screening exam consist of?

Measure your height and weight. Check your vital signs. Review your medical history and family medical history. Identify what medications or supplements you currently take.

What is a medical screening questionnaire?

The Medical Screening Questionnaire will include questions related to your personal and family medical history, drug allergies and more. Filling up this form accurately is important for our Medical Officers to determine your fitness for NS, and to consider your medical condition(s) during NS training.