Dive medicals and fit-to-dive sign-off on Koh Phi Phi
Every dive school on this island hands you a medical questionnaire before you get in the water, and a single yes on it means you need a doctor’s signature before the course goes ahead. Dive medical in Koh Phi Phi covers that clearance, and also the other half of the job — assessing somebody who has already dived and does not feel right afterwards.
The questionnaire, and what actually triggers it
The standard PADI and SSI form asks about a defined list, and the answers that most often need sign-off are asthma, any history of collapsed lung, ear or sinus surgery, epilepsy or seizures, diabetes, heart conditions, recent surgery, pregnancy, and certain psychiatric medications.
A yes does not mean no. Well-controlled asthma is frequently cleared, as is well-managed diabetes, and plenty of people dive safely with conditions the form flags. It is assessed properly rather than refused on the label.
What we cannot do is sign a form for somebody who has not been examined, or sign one that says something untrue. That is not bureaucracy — the form exists because certain conditions genuinely change what happens to a body at depth, and a signature that is not worth anything protects nobody.
The absolute barrier is a blocked nose
You can hold every certificate in the world and still not dive with a blocked nose, because you cannot equalise. The pressure has nowhere to go and the ear or sinus takes the load.
A sinus infection or an ear infection means postponing rather than pushing through. Using a decongestant to force a descent is a poor plan: if it wears off at depth, the reverse block on ascent is worse and can injure the sinus lining or the eardrum.
Come in the day before a course rather than the morning of. If a blockage needs a day or two of treatment, that is a rescheduled dive rather than a cancelled one, and a wax plug is a few minutes to clear.
What the examination involves
Blood pressure, pulse, oxygen saturation, a proper look at heart and lungs, and — the part that matters most for diving — examination of both ears and an assessment of whether you can equalise.
We go through your history and current medication, because some drugs matter at depth in ways they do not on land. Sedating antihistamines, some antidepressants and anything causing drowsiness all deserve a conversation rather than a box tick.
Where the picture warrants it, blood tests are run alongside. Most people are in and out inside twenty minutes with a signed form.
After a dive that did not feel right
This is the other half of the work and the more urgent half. Any of these after diving needs assessing immediately rather than sleeping on:
- Joint or limb pain, particularly shoulders and elbows
- Unusual fatigue out of proportion to the day
- Tingling, numbness or weakness anywhere
- Dizziness or difficulty with balance
- Confusion, or a headache that is not ordinary
- Any breathing difficulty or chest pain
- A rash with a mottled, marbled appearance
Those are treated as decompression illness until proved otherwise. Treatment is high-flow oxygen immediately and transfer to a recompression chamber, which is on the mainland — see evacuation and hospital transfer.
Why “I will see how I feel tomorrow” is the wrong plan
Decompression illness responds far better to early recompression than late. Symptoms that are mild in the evening can be significant by morning, and the delay is measured in outcome rather than inconvenience.
There is no chamber on Phi Phi. The nearest is in Phuket, roughly two hours away, and after dark that means chartering a boat rather than catching a ferry. Deciding at midnight is a materially worse position than deciding at nine in the evening — not because the medicine changes but because the transport does.
That combination — no chamber, a two-hour crossing, and boats that thin out after dark — is why we would much rather see somebody who turns out to be merely tired than have them go to bed with early symptoms. Come in. It costs a consultation.
Ears, which is what most divers actually come in for
Far more common than decompression illness, and far less dramatic. Pain during descent that did not clear, a blocked or muffled ear afterwards, or a sensation of fullness that persists for days.
That is usually ear barotrauma — pressure damage to the eardrum or middle ear — and it needs examining before you dive again rather than after. A perforated eardrum takes weeks, and diving on one is genuinely dangerous rather than merely uncomfortable.
Wax is the other frequent culprit and the easiest to fix. A plug that has swollen with water will stop you equalising on one side, and clearing it takes a few minutes.
Flying after diving, and the certificate you may need
Do not fly within the recommended interval after diving. The usual guidance is at least twelve hours after a single no-decompression dive and eighteen after multiple dives or several days of diving, and longer is safer.
On this island that means planning the last dive day around the ferry and the flight, not the other way round. People routinely dive in the morning, take an afternoon boat, and fly the same evening — which is exactly the sequence that produces problems at altitude, and it is the standard Phi Phi departure day.
If a dive school, an insurer or an employer needs documentation, we issue it in English, signed and stamped — see medical certificates.
Insurance, before you book the course
Check that your travel policy actually covers diving to the depth you are certified for, because a good number do not.
Common restrictions: no cover for scuba at all, cover only to eighteen or thirty metres, cover only with a qualified instructor present, or cover only if you already held certification before the trip. A recompression chamber treatment is expensive enough that this is worth ten minutes with the policy wording.
Read the document rather than the marketing page, and if it is ambiguous, email the insurer and keep the reply — see travel insurance claims. A specialist diving policy or a DAN membership costs considerably less than one chamber session.
Frequently asked questions
I answered yes on the dive medical form. Can I still dive?
Often yes. Well-controlled asthma and well-managed diabetes are frequently cleared. It is assessed properly rather than refused on the label.
Can I get the form signed the same day?
Usually within about twenty minutes, at any hour. Come the day before your course rather than the morning of, in case something needs treating first.
Can I dive with a cold?
No. You will not equalise, and forcing it risks barotrauma to the ear or sinus. Wait until the blockage has fully cleared.
Is there a recompression chamber on Koh Phi Phi?
No. The nearest is in Phuket, about two hours away. Suspected decompression illness needs oxygen immediately and a transfer.
My shoulder aches after diving. Is that serious?
It needs assessing now rather than in the morning. Joint pain after diving is treated as decompression illness until proved otherwise.
How long should I wait before flying?
At least twelve hours after a single dive, eighteen after multiple dives or several days of diving. Longer is safer.
Does my travel insurance cover diving?
Often only to a limited depth, or not at all. Check the policy wording before you book the course rather than after an incident.
Can I dive the day after a heavy night?
Better not. Dehydration measurably raises decompression risk, and every dive school here will tell you the same.
The island arithmetic, and where we fit in it
English-speaking doctors on site, 24 hours a day. It is worth spelling out why that matters rather than leaving it as a claim. Koh Phi Phi has no hospital, no road connection and no ambulance service. Getting to an emergency department means a boat, and the scheduled boats run in daylight — so for a good part of every twenty-four hours, the island’s own clinic is not the convenient option, it is the only one. Everything about how we are staffed follows from that single fact.
Beyond the island, Doctor Phi Phi Takecare Clinic belongs to the Takecare Clinic group, which operates across Krabi and Phuket. The practical value of that is continuity: if your treatment carries on after you leave, the next clinic already holds your notes, and a referral is a phone call between colleagues rather than a stack of paperwork you have to carry yourself.
Coming in
Doctor Phi Phi Takecare Clinic is 24 hours, every day, and that is the building being open with a doctor in it rather than a phone line that answers. No appointment is needed at any point, and there is no hour at which turning up is inconvenient for us. There are 2 branches on the island, about ten minutes apart on foot, and both keep the same hours — so head for whichever is closer rather than looking for the right one. Walk in, or reach us on +66 82 140 3858 or WhatsApp. If you would rather not move, ask for a doctor hotel visit and we will come to you.
If it turns out this is beyond what the island can treat, the same conversation is where the boat and the hospital transfer start being arranged. That process is worth beginning early rather than late here, because the options genuinely narrow as the evening goes on — and a decision made at nine is a considerably better decision than the same one made at two in the morning.