Online Reservations

Reservation forms must be sent by noon the day before. After that, please call 0980-87-5980.

To make a reservation, please agree to the health checklist below and fill out the reservation form.

If the form is successfully submitted, you will receive an auto-reply e-mail. After receiving the auto-reply e-mail, our staff will send you a confirmation e-mail usually within 24 hours. Please check the details of your reservation and if you agree, please send us your approval.

If you do not receive an email from our staff within 24 hours, please call us or email us at info@primescuba-ishigaki.com.

Please note the following when making reservations

The reservation form must be filled out by the participant himself/herself (or the representative in the case of a group). As a rule, we cannot accept applications by a proxy who will not be attending the event.

If you wish to make any changes or inquiries after making a reservation, please be sure to use the e-mail address you provided on the reservation form. We cannot accept e-mails sent from other addresses as we cannot confirm your identity.

Please be sure to have one representative contact us when making a group reservation.

If you are using non-Japanese based PC environment, please do not use this page, and go to the English page to send your form. (If you are using a non-Japanese based PC environment, please do not use this page, and go to the English page to send your form.)

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Please read carefully before signing.
　This medical history/diagnosis form is to confirm that you have been advised that diving involves a certain degree of risk and that your training program is something you must complete. Your signature is required to participate in the scuba diving program. You are also required to inform your instructor immediately of any changes in your health or other conditions that may occur during the scuba training program.
　Please read this statement carefully before signing. In order to participate in the Scuba Training Program, you must complete all sections of this Medical History/Diagnosis Statement. This statement includes questions regarding your illness. In the case of minors, the statement must be signed by a parent or guardian. Diving is an exciting sport, but it is also a hard activity. Diving is a relatively safe sport as long as the correct techniques are used. However, when safety procedures are not followed, the risks can increase.
　To enjoy scuba safely, you should not be extremely overweight or underestimate the conditions. Diving can be a very strenuous activity, depending on the conditions. The respiratory and circulatory systems must be healthy and all internal body spaces must be intact and healthy. People with coronary heart disease, current colds, congestion, epilepsy, severe medical problems, or a tendency toward alcohol or drug dependence should not dive. In addition, people with asthma, heart conditions, or other chronic medical conditions, or who are currently receiving regular medication, should consult with their physician and instructor before and periodically after participating in the program. In addition, breathing and pressure equalization for scuba diving will be taught by the instructor during the program. Incorrect use of scuba equipment can lead to serious injury. You must learn all aspects of safe equipment use under the direct supervision of a duly qualified instructor.
　If you have any questions about this medical history/diagnosis form, please review it again with your instructor before signing.
— Disease Questionnaire —
　This questionnaire is intended to help you determine if you should seek medical advice before participating in recreational scuba diving. Your answering Yes to each of the following questions does not mean that you are not qualified to dive. It does mean that you have a condition that may interfere with your safety when diving and that you need medical advice before participating in scuba diving.
　Please answer “Yes” or “No” to the following questions regarding your past and present health. If the answer is unknown, please answer “Yes” by indicating your safety. If “Yes”, you must consult with your physician before participating in scuba diving. Your instructor will provide you with a medical history/diagnosis form to take to your doctor and the Recreational Scuba Diver Medical Examination Guidelines.
⚫︎ currently pregnant or may become pregnant.
⚫︎ currently receiving prescription medication (excluding contraceptives and malaria prophylaxis).
⚫︎You are at least 45 years old and one or more of the following applies to you.
　- Smoking pipes, cigars, and cigarettes.
　- Currently receiving medical care.
　- High cholesterol levels.
　- Hypertension.
　- A family member has a history of heart attack or stroke.
　- He is diabetic, although he is adjusting his diet.
Have you ever had or are you currently suffering from any of the following diseases before ⚫︎?
　- Asthma, or wheezing when breathing, or wheezing during exercise, occurs or has occurred.
　- Severe or frequent attacks of hay fever or allergy symptoms.
　- Frequently suffers from colds, sinusitis, or bronchitis.
　- Has or has had some lung disease (e.g., pneumonia).
　- Has or has had a pneumothorax.
　- Have or have had other lung diseases. Or have had lung (chest) surgery.
　- Has or has had behavioral or mental/psychological problems (e.g., anxiety attacks, claustrophobia, agoraphobia).
　- Has epilepsy, seizures, or convulsions, or is taking medication to control them.
　- Has recurrent complex migraines or takes medications to control them.
　- Has lost consciousness or fainted. (complete or temporary loss of consciousness).
　- Frequent motion sickness. Or, I have severe motion sickness (e.g., seasickness, car sickness, etc.).
　- Dysentery or dehydration requiring treatment.
　- Is or has been in a diving accident or decompression sickness of some kind.
　- Inability to perform moderate physical activity (e.g., unable to walk a distance of approximately 1.6 kilometers in 12 minutes or less).
　- In the past 5 years, the patient has had a head injury that resulted in loss of consciousness.
　- Recurring back pain.
　- Has undergone lumbar or spinal surgery.
　- Is or has been a diabetic.
　- Post-surgical, traumatic or post-fracture injuries of the hip, arm, or leg.
　- Hypertension, or is or was taking medication to control blood pressure, such as blood pressure-lowering drugs.
　- Suffering from or had suffered from heart disease.
　- Has or has had a heart attack.
　- Angina pectoris or undergoing cardiac or arterial surgery
　- He has undergone sinus surgery.
　- The patient has an ear disease, surgery, hearing impairment, or balance disorder.
　- Repeatedly suffers from or has suffered from ear infections.
　- Has or had bleeding or other blood disorders.
　- Has or has had a hernia.
　- ulcer, or undergoing surgery for an ulcer.
　- He has undergone colorectal or ileal colostomy surgery.
　- Has used narcotics for recreation or for treatment or has become an alcoholic in the past 5 years.
The above information regarding my medical history is correct to the best of my knowledge. I confirm that I am obligated to inform my instructor of any and all changes in my medical history during the course of the scuba program. I agree to be responsible for any omissions regarding my current or past health status or failure to disclose any changes in my health status.

Please check the above medical history diagnosis and bring a doctor’s note if there are any problems.

Online Reservations

Prime Scuba Ishigaki Co, Ltd