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Swimmer Health & Medical Questionnaire Form

Run a swim-specific health check before getting in the water and capture conditions, medications, and emergency details.

Description

The Swimmer Health and Medical Questionnaire Form gives clubs and pools a thorough, swim-specific way to check health before someone gets in the water. Swimmers answer clear questions about asthma, seizures, ear or sinus issues, heart conditions, and pregnancy, so you understand any risks and can support each swimmer safely from their very first session.

Space to give details on anything answered yes, plus questions on medications and being under a doctor’s care, means nothing important is missed. Swimmer details, a parent or guardian name for under-18s, an emergency contact, and a declaration complete the questionnaire, giving you a reliable health record that helps you keep every swimmer safe in and around the water.

A quick health check keeps swimming safe for everyone. Sign up for a free Fun Forms account to customize the fields and embed this questionnaire on your website.

Form fields

Everything the Swimmer Health & Medical Questionnaire Form above collects — 15 fields across 3 pages, so you can see exactly what it captures before you make it your own.

Your Swim Health Check

  • Do you have asthma or breathing difficulties?

    Yes/No Icon
    Yes/No

  • Have you ever had a seizure, epilepsy, or blackout?

    Yes/No Icon
    Yes/No

  • Do you have ear, sinus, or grommet issues?

    Yes/No Icon
    Yes/No

  • Any heart condition or chest pain on exertion?

    Yes/No Icon
    Yes/No

  • Are you pregnant?

    Yes/No Icon
    Yes/No

  • Please give details for anything you answered yes to

    Long Answer Icon
    Long Answer

General Health

  • Do any of these apply?

    Multi-Select Icon
    Multi-Select

  • Any medications we should know about?

    Long Answer Icon
    Long Answer

  • Are you under a doctor's care for anything?

    Yes/No Icon
    Yes/No

Your Details

  • Swimmer's name

    Name Icon
    Name

  • Age

    Number Icon
    Number

  • Parent / guardian name (if under 18)

    Name Icon
    Name

  • Email address

    Email Icon
    Email

  • Emergency contact (name & number)

    Short Answer Icon
    Short Answer

  • Declaration

    Consent Icon
    Consent
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Template FAQs

Common questions about the Swimmer Health & Medical Questionnaire Form — what it captures, when to use it, and how to make it your own.

What is a swimmer health questionnaire?

It’s a swim-specific health check completed before someone starts swimming, covering conditions that matter in water such as asthma, seizures, and heart issues. Clubs and pools use it to understand risks and support each swimmer safely from the start.

Who should complete this questionnaire?

Any swimmer joining lessons, a squad, or a session should complete it, with a parent filling it in for under-18s. It suits swim schools, clubs, and pools that want a proper health record before anyone enters the water.

Why focus on ear, sinus, and breathing issues?

These conditions matter particularly in swimming, where water, pressure, and exertion can affect them. Asking about asthma, ear or sinus problems, and grommets lets staff support swimmers appropriately and respond well if an issue arises in the water.

What if I answer yes to something?

The form gives space to explain anything you answer yes to, so staff understand the detail. A yes doesn’t usually mean you can’t swim; it simply helps the club plan support, seek clearance where needed, and keep sessions safe for you.

Why collect an emergency contact and declaration?

An emergency contact lets staff reach someone quickly if needed, while the declaration confirms the information is accurate. Together they give the club a reliable, trusted health record and the reassurance to welcome each swimmer safely into the water.

Is this questionnaire free to use?

Yes — it’s completely free with a Fun Forms account. You can customize every field, restyle it to match your brand, embed it on your website in seconds, and it needs no coding at all.

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