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SURFERS HEALTH CHECK

Help us protect our surf spots by filling in the below form about any health problems you have experienced after a surf / kiteboard / swim / etc, in the ocean in The Netherlands.

SURFERS HEALTH CHECK

Name, Surname

E-mail

Tel number

Details Health Problem

Location where complaints originated from?

Date you've been in the water

Click on the complaints you experienced

Eye infection or other eye problems

Throat / nose / ear infection (and / or other ENT problems)

Shortness of breath, pressure in the chest or other breathing complaints

Skin irritation

Nausea

Other

If other, please provide more details below:

Have you visited a doctor with regard to the above health complaints?

Yes

No

If so, has the doctor confirmed that there is a link between the health complaints and the surf visit?

Yes

No

May we use your data for further research and / or may we contact you if necessary?

Yes

No

Thank you for filling out this form!

These files & their contents will not be published without the persons permission. We may use a summary of cases but would not use peoples actual names without permission.

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