{"id":14,"date":"2026-06-26T08:50:03","date_gmt":"2026-06-26T08:50:03","guid":{"rendered":"https:\/\/alvedasquaremc.co.za\/?page_id=14"},"modified":"2026-06-26T08:59:54","modified_gmt":"2026-06-26T08:59:54","slug":"dive-medical-report","status":"publish","type":"page","link":"https:\/\/alvedasquaremc.co.za\/?page_id=14","title":{"rendered":"DIVE MEDICAL REPORT"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14\" class=\"elementor elementor-14\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0add2e2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0add2e2\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1240770\" data-id=\"1240770\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ca12760 elementor-widget elementor-widget-heading\" data-id=\"ca12760\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">DIVE MEDICAL REPORT<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-41f2955 elementor-widget elementor-widget-spacer\" data-id=\"41f2955\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a79c3fa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a79c3fa\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-82b0d5c\" data-id=\"82b0d5c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2224714 elementor-widget elementor-widget-shortcode\" data-id=\"2224714\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-13 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-13\" data-uid=\"6a3e716d8d3d7\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-13\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-13 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"13\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a3e716d8d3d7\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a3e716d8d3d7\" id=\"forminator-field-name-1_6a3e716d8d3d7-label\" class=\"forminator-label\">Surname <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a3e716d8d3d7\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a3e716d8d3d7\" id=\"forminator-field-name-2_6a3e716d8d3d7-label\" class=\"forminator-label\">First Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_6a3e716d8d3d7\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a3e716d8d3d7\" id=\"forminator-field-email-1_6a3e716d8d3d7-label\" class=\"forminator-label\">Phsical Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a3e716d8d3d7\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a3e716d8d3d7\" id=\"forminator-field-phone-1_6a3e716d8d3d7-label\" class=\"forminator-label\">Phone Number<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6a3e716d8d3d7\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a3e716d8d3d7\" id=\"forminator-field-email-2_6a3e716d8d3d7-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a3e716d8d3d7\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-3\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-3_6a3e716d8d3d7\" id=\"forminator-field-email-3_6a3e716d8d3d7-label\" class=\"forminator-label\">Date of Birth <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-3\" value=\"\" placeholder=\"\" id=\"forminator-field-email-3_6a3e716d8d3d7\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-4\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-4_6a3e716d8d3d7\" id=\"forminator-field-email-4_6a3e716d8d3d7-label\" class=\"forminator-label\">Date of Birth <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-4\" value=\"\" placeholder=\"\" id=\"forminator-field-email-4_6a3e716d8d3d7\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a3e716d8d3d7\" id=\"forminator-field-textarea-1_6a3e716d8d3d7-label\" class=\"forminator-label\">Nationality<\/label><span id=\"forminator-field-textarea-1_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a3e716d8d3d7\" id=\"forminator-field-textarea-2_6a3e716d8d3d7-label\" class=\"forminator-label\">ID\/Passport Number<\/label><span id=\"forminator-field-textarea-2_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a3e716d8d3d7\" id=\"forminator-field-textarea-3_6a3e716d8d3d7-label\" class=\"forminator-label\">Gender<\/label><span id=\"forminator-field-textarea-3_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a3e716d8d3d7\" id=\"forminator-field-textarea-4_6a3e716d8d3d7-label\" class=\"forminator-label\">Age<\/label><span id=\"forminator-field-textarea-4_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-13__field--select-1_6a3e716d8d3d7\" id=\"forminator-form-13__field--select-1_6a3e716d8d3d7-label\" class=\"forminator-label\">Diver Class<\/label><select multiple id=\"forminator-form-13__field--select-1_6a3e716d8d3d7\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1[]\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Diver Class\" data-search=\"false\" data-search-placeholder=\"Search\" data-checkbox=\"false\" data-allow-clear=\"true\" aria-labelledby=\"forminator-form-13__field--select-1_6a3e716d8d3d7-label\"><option value=\"I\"  data-calculation=\"0\">I<\/option><option value=\"II\"  data-calculation=\"0\">II<\/option><option value=\"Air\"  data-calculation=\"0\">II Air<\/option><option value=\"Mix-Gas\"  data-calculation=\"0\">II Mix Gas<\/option><option value=\"III\"  data-calculation=\"0\">III<\/option><option value=\"IV\"  data-calculation=\"0\">III Air<\/option><option value=\"III-Mix-Gas\"  data-calculation=\"0\">III Mix Gas<\/option><option value=\"V\"  data-calculation=\"0\">IV<\/option><option value=\"V-Air\"  data-calculation=\"0\">IV Air<\/option><option value=\"V-Mix-Gas\"  data-calculation=\"0\">IV Mix Gas<\/option><option value=\"V\"  data-calculation=\"0\">V<\/option><option value=\"V1\"  data-calculation=\"0\">VI<\/option><option value=\"Supervisor\"  data-calculation=\"0\">Supervisor<\/option><option value=\"Instructor\"  data-calculation=\"0\">Instructor<\/option><option value=\"Technical\"  data-calculation=\"0\">Technical<\/option><option value=\"Recreational\"  data-calculation=\"0\">Recreational<\/option><\/select><\/div><\/div><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a3e716d8d3d7\" id=\"forminator-field-textarea-5_6a3e716d8d3d7-label\" class=\"forminator-label\">Previous Medical Examination Date<\/label><span id=\"forminator-field-textarea-5_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a3e716d8d3d7-label\" class=\"forminator-label\">Have you ever had a diving medical assessment denied, suspended, revoked or referred for panel opinion?<\/span><label id=\"forminator-field-checkbox-1-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-1-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-1-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-1-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-1-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a3e716d8d3d7-label\" class=\"forminator-label\">Have you EVER had any diving related accident, injury, illness or problem, especially since your last medical?<\/span><label id=\"forminator-field-checkbox-2-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-2-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-2-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-2-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-2-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6a3e716d8d3d7\" id=\"forminator-field-textarea-6_6a3e716d8d3d7-label\" class=\"forminator-label\">Average weekly alcohol consumption in units (1unit= 340ml beer \/1Tot measure spirit\/1 glass wine):<\/label><span id=\"forminator-field-textarea-6_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-6a3e716d8d3d7-label\" class=\"forminator-label\">Smoking<\/span><label id=\"forminator-field-checkbox-3-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-3-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-3-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-3-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-3-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6a3e716d8d3d7\" id=\"forminator-field-textarea-7_6a3e716d8d3d7-label\" class=\"forminator-label\">Cigarettes\/Day<\/label><span id=\"forminator-field-textarea-7_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-4 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a3e716d8d3d7-label\" class=\"forminator-label\">Previous Smoker<\/span><label id=\"forminator-field-checkbox-4-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-4-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-4-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-4-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-4-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_6a3e716d8d3d7\" id=\"forminator-field-textarea-8_6a3e716d8d3d7-label\" class=\"forminator-label\">Cigarettes\/Day<\/label><span id=\"forminator-field-textarea-8_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><div id=\"textarea-9\" class=\"forminator-field-textarea forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-9_6a3e716d8d3d7\" id=\"forminator-field-textarea-9_6a3e716d8d3d7-label\" class=\"forminator-label\">Year Stopped<\/label><span id=\"forminator-field-textarea-9_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-9\" placeholder=\"\" id=\"forminator-field-textarea-9_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a3e716d8d3d7-label\" class=\"forminator-label\">Currently using ANY Medication, Sub-stances or Therapy?<\/span><label id=\"forminator-field-checkbox-5-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-5-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-5-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-5-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-5-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"textarea-10\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-10_6a3e716d8d3d7\" id=\"forminator-field-textarea-10_6a3e716d8d3d7-label\" class=\"forminator-label\">If Yes, List:<\/label><span id=\"forminator-field-textarea-10_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-10\" placeholder=\"\" id=\"forminator-field-textarea-10_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6a3e716d8d3d7-label\" class=\"forminator-label\">ANY implants \/ devices?<\/span><label id=\"forminator-field-checkbox-6-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-6-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-6-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-6-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-6-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"textarea-11\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-11_6a3e716d8d3d7\" id=\"forminator-field-textarea-11_6a3e716d8d3d7-label\" class=\"forminator-label\">If Yes, List:<\/label><span id=\"forminator-field-textarea-11_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-11\" placeholder=\"\" id=\"forminator-field-textarea-11_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-12\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-12_6a3e716d8d3d7\" id=\"forminator-field-textarea-12_6a3e716d8d3d7-label\" class=\"forminator-label\">Exercise: Type, frequency, intensity<\/label><span id=\"forminator-field-textarea-12_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-12\" placeholder=\"\" id=\"forminator-field-textarea-12_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-13\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-13_6a3e716d8d3d7\" id=\"forminator-field-textarea-13_6a3e716d8d3d7-label\" class=\"forminator-label\">Diving Experience: Frequency, No Dives<\/label><span id=\"forminator-field-textarea-13_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-13\" placeholder=\"\" id=\"forminator-field-textarea-13_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-14\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-14_6a3e716d8d3d7\" id=\"forminator-field-textarea-14_6a3e716d8d3d7-label\" class=\"forminator-label\">Doctors Notes<\/label><span id=\"forminator-field-textarea-14_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-14\" placeholder=\"\" id=\"forminator-field-textarea-14_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Medical History:<\/h2><h3 class=\"forminator-subtitle\">Do you have, or have you ever had, any of the following? Tick Yes or No. If unsure, leave blank.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6a3e716d8d3d7-label\" class=\"forminator-label\">1a. Eye disorders\/ Eye surgery \/ Corrective lenses<\/span><label id=\"forminator-field-checkbox-7-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-7-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-7-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-7-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"two\" id=\"forminator-field-checkbox-7-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-7-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6a3e716d8d3d7-label\" class=\"forminator-label\">23. ANY mental illness or mental health issues requiring medication or intervention (counselling)<\/span><label id=\"forminator-field-checkbox-9-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-9-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-9-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-9-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-9-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-9-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6a3e716d8d3d7-label\" class=\"forminator-label\">1b. Corrective aid: prescription changed since last medical?<\/span><label id=\"forminator-field-checkbox-8-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-8-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"one\" id=\"forminator-field-checkbox-8-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-8-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-8-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-8-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"two\" id=\"forminator-field-checkbox-8-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-8-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6a3e716d8d3d7-label\" class=\"forminator-label\">24. Drug \/ Substance abuse or addiction. Mention recreation use please<\/span><label id=\"forminator-field-checkbox-10-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-10-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-10-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-10-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-10-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-10-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-11-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-11-6a3e716d8d3d7-label\" class=\"forminator-label\">2. Sinus problems, hay fever or allergies<\/span><label id=\"forminator-field-checkbox-11-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-11-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"one\" id=\"forminator-field-checkbox-11-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-11-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-11-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-11-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"two\" id=\"forminator-field-checkbox-11-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-11-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-12-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-12-6a3e716d8d3d7-label\" class=\"forminator-label\">25. Musculoskeletal impairment or impaired mobility<\/span><label id=\"forminator-field-checkbox-12-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-12-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"one\" id=\"forminator-field-checkbox-12-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-12-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-12-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-12-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"two\" id=\"forminator-field-checkbox-12-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-12-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-17\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-17-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-17-6a3e716d8d3d7-label\" class=\"forminator-label\">3. Nose &amp; throat\/ Speech problems<\/span><label id=\"forminator-field-checkbox-17-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-17-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"one\" id=\"forminator-field-checkbox-17-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-17-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-17-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-17-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"two\" id=\"forminator-field-checkbox-17-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-17-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-16\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-16-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-16-6a3e716d8d3d7-label\" class=\"forminator-label\">26. Stomach \/ Liver \/ Gall tract \/ Bowel disorders. Hernia?<\/span><label id=\"forminator-field-checkbox-16-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-16-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"one\" id=\"forminator-field-checkbox-16-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-16-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-16-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-16-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"two\" id=\"forminator-field-checkbox-16-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-16-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-15-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-15-6a3e716d8d3d7-label\" class=\"forminator-label\">4. Dental problems \/ dentures \/ dental surgery<\/span><label id=\"forminator-field-checkbox-15-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-15-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-15-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-15-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-15-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-15-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6a3e716d8d3d7-label\" class=\"forminator-label\">27. Hormonal disorders: particularly diabetes<\/span><label id=\"forminator-field-checkbox-14-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-14-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"one\" id=\"forminator-field-checkbox-14-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-14-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-14-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-14-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-14-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-13-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-13-6a3e716d8d3d7-label\" class=\"forminator-label\">5. Ear: deafness \/ injury \/ discharge \/ surgery to ears<\/span><label id=\"forminator-field-checkbox-13-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-13-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-13-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-13-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-13-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-13-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-18\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-18-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-18-6a3e716d8d3d7-label\" class=\"forminator-label\">28. Renal problems: blood in urine \/ history of kidney stones.<\/span><label id=\"forminator-field-checkbox-18-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-18-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"one\" id=\"forminator-field-checkbox-18-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-18-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-18-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-18-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"two\" id=\"forminator-field-checkbox-18-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-18-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-19\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-19-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-19-6a3e716d8d3d7-label\" class=\"forminator-label\">6. Ear issues or Headache when flying<\/span><label id=\"forminator-field-checkbox-19-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-19-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"one\" id=\"forminator-field-checkbox-19-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-19-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-19-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-19-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"two\" id=\"forminator-field-checkbox-19-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-19-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-20\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-20-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-20-6a3e716d8d3d7-label\" class=\"forminator-label\">29. Vomiting blood or passing blood on bowel motions<\/span><label id=\"forminator-field-checkbox-20-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-20-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"one\" id=\"forminator-field-checkbox-20-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-20-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-20-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-20-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"two\" id=\"forminator-field-checkbox-20-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-20-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-21\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-21-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-21-6a3e716d8d3d7-label\" class=\"forminator-label\">7. Motion sickness, severe enough to require medication<\/span><label id=\"forminator-field-checkbox-21-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-21-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"one\" id=\"forminator-field-checkbox-21-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-21-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-21-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-21-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"two\" id=\"forminator-field-checkbox-21-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-21-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-22\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-22-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-22-6a3e716d8d3d7-label\" class=\"forminator-label\">30. Blood disorders: anaemia, sickle cell, clotting disorders<\/span><label id=\"forminator-field-checkbox-22-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-22-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"one\" id=\"forminator-field-checkbox-22-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-22-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-22-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-22-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"two\" id=\"forminator-field-checkbox-22-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-22-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-28\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-28-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-28-6a3e716d8d3d7-label\" class=\"forminator-label\">8. ANY shortness of breath \/ cough \/ wheezing \/ lung disorders<\/span><label id=\"forminator-field-checkbox-28-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-28-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"one\" id=\"forminator-field-checkbox-28-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-28-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-28-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-28-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-28[]\" value=\"two\" id=\"forminator-field-checkbox-28-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-28-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-27\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-27-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-27-6a3e716d8d3d7-label\" class=\"forminator-label\">31. Gynaecological issues (menstrual, pregnancy, ovarian, etc)<\/span><label id=\"forminator-field-checkbox-27-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-27-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"one\" id=\"forminator-field-checkbox-27-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-27-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-27-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-27-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"two\" id=\"forminator-field-checkbox-27-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-27-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-25\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-25-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-25-6a3e716d8d3d7-label\" class=\"forminator-label\">9. History of pneumothorax (collapsed lung), penetrating chest injuries or open chest surgery<\/span><label id=\"forminator-field-checkbox-25-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-25-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"one\" id=\"forminator-field-checkbox-25-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-25-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-25-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-25-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"two\" id=\"forminator-field-checkbox-25-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-25-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-24\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-24-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-24-6a3e716d8d3d7-label\" class=\"forminator-label\">32. Prostate problems<\/span><label id=\"forminator-field-checkbox-24-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-24-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"one\" id=\"forminator-field-checkbox-24-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-24-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-24-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-24-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"two\" id=\"forminator-field-checkbox-24-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-24-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-23\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-23-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-23-6a3e716d8d3d7-label\" class=\"forminator-label\">10. History of Immersion Pulmonary oedema or shortness of breath in the water.<\/span><label id=\"forminator-field-checkbox-23-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-23-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"one\" id=\"forminator-field-checkbox-23-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-23-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-23-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-23-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"two\" id=\"forminator-field-checkbox-23-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-23-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-29\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-29-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-29-6a3e716d8d3d7-label\" class=\"forminator-label\">33. Sexually transmissible diseases<\/span><label id=\"forminator-field-checkbox-29-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-29-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"one\" id=\"forminator-field-checkbox-29-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-29-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-29-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-29-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-29[]\" value=\"two\" id=\"forminator-field-checkbox-29-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-29-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-32\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-32-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-32-6a3e716d8d3d7-label\" class=\"forminator-label\">11. ANY Heart disease incl blood vessel, valve or muscle<\/span><label id=\"forminator-field-checkbox-32-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-32-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"one\" id=\"forminator-field-checkbox-32-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-32-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-32-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-32-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-32[]\" value=\"two\" id=\"forminator-field-checkbox-32-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-32-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-31\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-31-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-31-6a3e716d8d3d7-label\" class=\"forminator-label\">34. Tropical diseases: Malaria, Cholera, Dengue<\/span><label id=\"forminator-field-checkbox-31-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-31-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"one\" id=\"forminator-field-checkbox-31-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-31-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-31-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-31-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-31[]\" value=\"two\" id=\"forminator-field-checkbox-31-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-31-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-30\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-30-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-30-6a3e716d8d3d7-label\" class=\"forminator-label\">12. Racing or irregular heart beat<\/span><label id=\"forminator-field-checkbox-30-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-30-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"one\" id=\"forminator-field-checkbox-30-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-30-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-30-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-30-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-30[]\" value=\"two\" id=\"forminator-field-checkbox-30-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-30-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-26\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-26-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-26-6a3e716d8d3d7-label\" class=\"forminator-label\">35. Infective diseases: HIV, Hepatitis, Tuberculosis<\/span><label id=\"forminator-field-checkbox-26-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-26-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"one\" id=\"forminator-field-checkbox-26-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-26-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-26-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-26-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"two\" id=\"forminator-field-checkbox-26-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-26-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-33\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-33-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-33-6a3e716d8d3d7-label\" class=\"forminator-label\">13. Chest pain or discomfort on exercise<\/span><label id=\"forminator-field-checkbox-33-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-33-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"one\" id=\"forminator-field-checkbox-33-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-33-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-33-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-33-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-33[]\" value=\"two\" id=\"forminator-field-checkbox-33-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-33-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-42\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-42-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-42-6a3e716d8d3d7-label\" class=\"forminator-label\">36a. Have you been diagnosed with Covid OR had suspicious symptoms of Covid during the last 2 years<\/span><label id=\"forminator-field-checkbox-42-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-42-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"one\" id=\"forminator-field-checkbox-42-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-42-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-42-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-42-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-42[]\" value=\"two\" id=\"forminator-field-checkbox-42-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-42-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-41\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-41-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-41-6a3e716d8d3d7-label\" class=\"forminator-label\">14. Blood pressure problems \u2013 high OR low<\/span><label id=\"forminator-field-checkbox-41-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-41-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"one\" id=\"forminator-field-checkbox-41-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-41-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-41-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-41-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-41[]\" value=\"two\" id=\"forminator-field-checkbox-41-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-41-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-40\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-40-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-40-6a3e716d8d3d7-label\" class=\"forminator-label\">36b. Have you been vaccinated against Covid<\/span><label id=\"forminator-field-checkbox-40-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-40-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"one\" id=\"forminator-field-checkbox-40-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-40-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-40-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-40-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-40[]\" value=\"two\" id=\"forminator-field-checkbox-40-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-40-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-39\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-39-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-39-6a3e716d8d3d7-label\" class=\"forminator-label\">15. High cholesterol<\/span><label id=\"forminator-field-checkbox-39-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-39-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"one\" id=\"forminator-field-checkbox-39-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-39-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-39-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-39-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-39[]\" value=\"two\" id=\"forminator-field-checkbox-39-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-39-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-38\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-38-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-38-6a3e716d8d3d7-label\" class=\"forminator-label\">37. Cancers \/ Malignancies<\/span><label id=\"forminator-field-checkbox-38-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-38-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"one\" id=\"forminator-field-checkbox-38-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-38-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-38-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-38-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-38[]\" value=\"two\" id=\"forminator-field-checkbox-38-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-38-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-37\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-37-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-37-6a3e716d8d3d7-label\" class=\"forminator-label\">16. Blood clots in legs, lungs or history of stroke<\/span><label id=\"forminator-field-checkbox-37-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-37-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"one\" id=\"forminator-field-checkbox-37-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-37-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-37-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-37-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-37[]\" value=\"two\" id=\"forminator-field-checkbox-37-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-37-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-36\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-36-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-36-6a3e716d8d3d7-label\" class=\"forminator-label\">38. Admission to hospital NOT related to elective surgery<\/span><label id=\"forminator-field-checkbox-36-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-36-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"one\" id=\"forminator-field-checkbox-36-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-36-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-36-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-36-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-36[]\" value=\"two\" id=\"forminator-field-checkbox-36-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-36-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-35\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-35-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-35-6a3e716d8d3d7-label\" class=\"forminator-label\">17. Sleep apnoea\/severe snoring\/waking up tired or breathless<\/span><label id=\"forminator-field-checkbox-35-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-35-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"one\" id=\"forminator-field-checkbox-35-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-35-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-35-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-35-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-35[]\" value=\"two\" id=\"forminator-field-checkbox-35-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-35-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-34\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-34-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-34-6a3e716d8d3d7-label\" class=\"forminator-label\">39. Known allergies<\/span><label id=\"forminator-field-checkbox-34-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-34-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"one\" id=\"forminator-field-checkbox-34-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-34-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-34-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-34-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-34[]\" value=\"two\" id=\"forminator-field-checkbox-34-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-34-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-44\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-44-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-44-6a3e716d8d3d7-label\" class=\"forminator-label\">18. Head injury. Concussion or CT or MRI scan investigations<\/span><label id=\"forminator-field-checkbox-44-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-44-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"one\" id=\"forminator-field-checkbox-44-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-44-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-44-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-44-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-44[]\" value=\"two\" id=\"forminator-field-checkbox-44-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-44-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-43\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-43-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-43-6a3e716d8d3d7-label\" class=\"forminator-label\">40. ANY OTHER ILLNESS, INJURY or OPERATION NOT MENTIONED ABOVE<\/span><label id=\"forminator-field-checkbox-43-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-43-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"one\" id=\"forminator-field-checkbox-43-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-43-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-43-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-43-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-43[]\" value=\"two\" id=\"forminator-field-checkbox-43-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-43-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-45\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-45-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-45-6a3e716d8d3d7-label\" class=\"forminator-label\">19. Sever \/ frequent headaches; including migraine<\/span><label id=\"forminator-field-checkbox-45-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-45-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"one\" id=\"forminator-field-checkbox-45-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-45-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-45-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-45-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-45[]\" value=\"two\" id=\"forminator-field-checkbox-45-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-45-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-51\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-51-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-51-6a3e716d8d3d7-label\" class=\"forminator-label\">41. Any visit to your doctor since your last dive medical?<\/span><label id=\"forminator-field-checkbox-51-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-51-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"one\" id=\"forminator-field-checkbox-51-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-51-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-51-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-51-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-51[]\" value=\"two\" id=\"forminator-field-checkbox-51-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-51-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-50\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-50-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-50-6a3e716d8d3d7-label\" class=\"forminator-label\">20. Light headedness\/dizziness\/unconsciousness for ANY reason<\/span><label id=\"forminator-field-checkbox-50-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-50-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"one\" id=\"forminator-field-checkbox-50-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-50-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-50-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-50-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-50[]\" value=\"two\" id=\"forminator-field-checkbox-50-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-50-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-49\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-49-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-49-6a3e716d8d3d7-label\" class=\"forminator-label\">42. Refusal for granting life insurance cover<\/span><label id=\"forminator-field-checkbox-49-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-49-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"one\" id=\"forminator-field-checkbox-49-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-49-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-49-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-49-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-49[]\" value=\"two\" id=\"forminator-field-checkbox-49-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-49-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-48\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-48-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-48-6a3e716d8d3d7-label\" class=\"forminator-label\">21. Neurological: epilepsy, seizures, paralysis, numbness<\/span><label id=\"forminator-field-checkbox-48-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-48-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"one\" id=\"forminator-field-checkbox-48-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-48-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-48-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-48-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-48[]\" value=\"two\" id=\"forminator-field-checkbox-48-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-48-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-47\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-47-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-47-6a3e716d8d3d7-label\" class=\"forminator-label\">43. Refusal or revocation of diving fitness<\/span><label id=\"forminator-field-checkbox-47-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-47-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"one\" id=\"forminator-field-checkbox-47-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-47-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-47-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-47-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-47[]\" value=\"two\" id=\"forminator-field-checkbox-47-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-47-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-46\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-46-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-46-6a3e716d8d3d7-label\" class=\"forminator-label\">22. Claustrophobia<\/span><label id=\"forminator-field-checkbox-46-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-46-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"one\" id=\"forminator-field-checkbox-46-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-46-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-46-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-46-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-46[]\" value=\"two\" id=\"forminator-field-checkbox-46-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-46-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-52\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-52-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-52-6a3e716d8d3d7-label\" class=\"forminator-label\">44. Recipient of incapacity OR compensation pay for injury\/illness<\/span><label id=\"forminator-field-checkbox-52-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-52-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"one\" id=\"forminator-field-checkbox-52-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-52-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-52-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-52-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-52[]\" value=\"two\" id=\"forminator-field-checkbox-52-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-52-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Family History Of:<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-53\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-53-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-53-6a3e716d8d3d7-label\" class=\"forminator-label\">45. Heart disease, blood vessel disease or rhythm disorders<\/span><label id=\"forminator-field-checkbox-53-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-53-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"one\" id=\"forminator-field-checkbox-53-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-53-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-53-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-53-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-53[]\" value=\"two\" id=\"forminator-field-checkbox-53-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-53-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-64\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-64-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-64-6a3e716d8d3d7-label\" class=\"forminator-label\">51. Diabetes<\/span><label id=\"forminator-field-checkbox-64-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-64-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"one\" id=\"forminator-field-checkbox-64-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-64-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-64-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-64-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-64[]\" value=\"two\" id=\"forminator-field-checkbox-64-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-64-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-63\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-63-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-63-6a3e716d8d3d7-label\" class=\"forminator-label\">46. Sudden death at young age<\/span><label id=\"forminator-field-checkbox-63-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-63-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"one\" id=\"forminator-field-checkbox-63-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-63-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-63-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-63-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-63[]\" value=\"two\" id=\"forminator-field-checkbox-63-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-63-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-62\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-62-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-62-6a3e716d8d3d7-label\" class=\"forminator-label\">52. Tuberculosis<\/span><label id=\"forminator-field-checkbox-62-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-62-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"one\" id=\"forminator-field-checkbox-62-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-62-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-62-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-62-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-62[]\" value=\"two\" id=\"forminator-field-checkbox-62-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-62-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-61\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-61-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-61-6a3e716d8d3d7-label\" class=\"forminator-label\">47. High blood pressure<\/span><label id=\"forminator-field-checkbox-61-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-61-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"one\" id=\"forminator-field-checkbox-61-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-61-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-61-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-61-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-61[]\" value=\"two\" id=\"forminator-field-checkbox-61-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-61-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-54\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-54-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-54-6a3e716d8d3d7-label\" class=\"forminator-label\">53. Allergy \/ Asthma \/ Eczema<\/span><label id=\"forminator-field-checkbox-54-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-54-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"one\" id=\"forminator-field-checkbox-54-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-54-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-54-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-54-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-54[]\" value=\"two\" id=\"forminator-field-checkbox-54-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-54-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-60\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-60-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-60-6a3e716d8d3d7-label\" class=\"forminator-label\">48. High cholesterol<\/span><label id=\"forminator-field-checkbox-60-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-60-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"one\" id=\"forminator-field-checkbox-60-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-60-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-60-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-60-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-60[]\" value=\"two\" id=\"forminator-field-checkbox-60-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-60-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-59\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-59-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-59-6a3e716d8d3d7-label\" class=\"forminator-label\">54. Inherited disorders<\/span><label id=\"forminator-field-checkbox-59-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-59-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"one\" id=\"forminator-field-checkbox-59-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-59-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-59-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-59-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-59[]\" value=\"two\" id=\"forminator-field-checkbox-59-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-59-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-58\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-58-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-58-6a3e716d8d3d7-label\" class=\"forminator-label\">49. Epilepsy<\/span><label id=\"forminator-field-checkbox-58-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-58-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"one\" id=\"forminator-field-checkbox-58-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-58-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-58-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-58-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-58[]\" value=\"two\" id=\"forminator-field-checkbox-58-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-58-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-57\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-57-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-57-6a3e716d8d3d7-label\" class=\"forminator-label\">55. Glaucoma<\/span><label id=\"forminator-field-checkbox-57-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-57-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"one\" id=\"forminator-field-checkbox-57-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-57-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-57-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-57-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-57[]\" value=\"two\" id=\"forminator-field-checkbox-57-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-57-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-56\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-56-6a3e716d8d3d7-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-56-6a3e716d8d3d7-label\" class=\"forminator-label\">50. Mental illness or psychiatric treatment<\/span><label id=\"forminator-field-checkbox-56-1-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-56-1-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"one\" id=\"forminator-field-checkbox-56-1-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-56-1-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-56-2-6a3e716d8d3d7-label\" for=\"forminator-field-checkbox-56-2-6a3e716d8d3d7\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-56[]\" value=\"two\" id=\"forminator-field-checkbox-56-2-6a3e716d8d3d7\" aria-labelledby=\"forminator-field-checkbox-56-2-6a3e716d8d3d7-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-15\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-15_6a3e716d8d3d7\" id=\"forminator-field-textarea-15_6a3e716d8d3d7-label\" class=\"forminator-label\">REMARKS\/EXPLANATIONS OF ALL RESPONSE ANSWERED \u2018Yes\u2019:<\/label><span id=\"forminator-field-textarea-15_6a3e716d8d3d7-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-15\" placeholder=\"\" id=\"forminator-field-textarea-15_6a3e716d8d3d7\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">I hereby declare that I have carefully considered the statements I have made above and that to the best of my belief they are complete and correct. I further declare that I have not withheld any relevant information or made any misleading statements. I understand that if I have made any false or misleading statement in connection with this application, or if I do not consent to release the supporting medical information, the Authority may refuse to grant me medical clearance or may withdraw any medical clearance granted, without prejudice to any other legal action applicable.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Consent to release of medical information: I hereby give my consent that all relevant medical information may be released and submitted to the medical assessor of the Licensing Authority.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Note: Medical Confidentiality will be respected all times.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a3e716d8d3d7\" id=\"forminator-field-name-3_6a3e716d8d3d7-label\" class=\"forminator-label\">Name<\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"\" id=\"forminator-field-name-3_6a3e716d8d3d7\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a3e716d8d3d7\" id=\"forminator-field-date-1-picker_6a3e716d8d3d7-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-1-picker_6a3e716d8d3d7\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"e41c920e36\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F14\" \/><input type=\"hidden\" name=\"form_id\" value=\"13\"><input type=\"hidden\" name=\"page_id\" value=\"14\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/alvedasquaremc.co.za\/?page_id=14\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>DIVE MEDICAL REPORT<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-14","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>DIVE MEDICAL REPORT - Occupational Medicals<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alvedasquaremc.co.za\/?page_id=14\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"DIVE MEDICAL REPORT - Occupational Medicals\" \/>\n<meta property=\"og:description\" content=\"DIVE MEDICAL REPORT\" \/>\n<meta property=\"og:url\" content=\"https:\/\/alvedasquaremc.co.za\/?page_id=14\" \/>\n<meta property=\"og:site_name\" content=\"Occupational Medicals\" \/>\n<meta property=\"article:modified_time\" content=\"2026-06-26T08:59:54+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/alvedasquaremc.co.za\\\/?page_id=14\",\"url\":\"https:\\\/\\\/alvedasquaremc.co.za\\\/?page_id=14\",\"name\":\"DIVE MEDICAL REPORT - 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