Medical Questionnaire
(All answers are confidential between Captain and Guest) Guest name:
_____________________________________________
Are you allergic to any Foods, Yes __or No __
If answer is yes, please describe,
_____________________________________________
_____________________________________________
Are you allergic to Medications, Yes __or No__
If answer is yes, please describe
_____________________________________________
_____________________________________________
Are you diabetic, Yes __ or No__

Are you taking medication for “serious” health conditions,
Yes __or No__
If answer is yes, please describe.
_____________________________________________
_____________________________________________
Have you ever experienced any type of Sea Sickness,
Yes __or No__
If answer is yes, please describe
_____________________________________________
_____________________________________________