Could you be pregnant or are you attempting to become pregnant?

 Do you regularly take prescription or non prescription medications
    other than birth control medications?

 Are you over 45 years of age and have one or more of the following?
      - currently smoke a pipe, cigars, or cigarettes
      - have a high cholesterol level
      - have a family history of heart attacks or strokes


Have you ever had or do you currently have ...

 Asthma or wheezing with breathing, or wheezing with exercise?

 Frequent or severe attacks of hay fever or allergies?

 Frequent colds, sinusitis or bronchitis?

 Any form of lung disease?

 Pneumothorax (collapsed lung)?

 History of chest surgery?

 Claustrophobia or agoraphobia ( fear of closed or open spaces)?

 Behavioral health problems?

 Epilepsy, seizures, convulsions or take medications to prevent them?

 Recurring migraine headaches or take medications to prevent them?

 History of blackouts or fainting (full/partial loss of consciousness)?

 Do you frequently suffer from motion sickness (seasick, carsick, etc.)?

 History of diving accidents or decompression sickness?

 History of recurrent back problems?

 History of back surgery?

 History of diabetes?

 History of back, arm, or leg problems following surgery, injury, or fracture?

 Inability to perform moderate exercise (example walk one mile in 12 minutes)?

 History of high blood pressure or take medicine to control blood pressure?

 History of any heart disease?

 History of heart attacks?

 Angina or heart surgery or blood vessel surgery?

 History of ear or sinus surgery?

 History of ear disease, hearing loss or problems of balance?

 History of problems equalizing (popping) ears with airplane travel?

 History of bleeding or other blood disorders?

 History of any type of hernia?

 History of ulcers or ulcer surgery?

 History of colostomy?