Health History
The following information is requested. This information will be kept confidential and shared only when as deemed needed. Any changes to this information must be provided to the boat captain. Please provide complete information, so that we can be aware of your needs.
List all known and describe reaction and management of the reaction. Medical, Food, or Other
Please list any dietary restrictions including lactose intolerance, diabetics gluten free, or if
you are a vegetarian.
List the Medication, Reason for Taking, Dosage, and Times a day taken.
Use this space to provide any additional information about which the Boat Captain should be aware
Please be specific such as liver, broccoli, Brussels sprouts, fish, mushrooms, etc.
Please feel free to include or add anything else that will assist the crew in planning your time on Serena.
