This form is completed by a physician once a diver’s fitness exam has been performed.

Please note the form’s functionality will not work properly if the form is opened in an internet browser such as Microsoft Edge or Google Chrome.

You will need to complete the form using Adobe Acrobat Reader.

To complete and submit the form digitally:

1. Click the Download PDF button. The form will be copied to the Downloads folder on your computer hard drive.
2. Open the form in Acrobat by going to your Downloads folder and right-clicking on the PDF file. Select Open with > Adobe Acrobat Reader.
3. Type the requested information into the fields. Save your form, then click the Submit button. A pop-up menu will appear; select “Default email application (Outlook).” Outlook will open an email to Certification Services. Ensure your completed form is attached, then click Send.
4. Provide the diver with a copy of the certificate by print or email.