I just checked the Spirit of Freedoms webpage. A medical clearance is still required if you answer yes to any of the medical questions on the Diver Information Form (see Spirit of Freedom - Diver Information Form - +61 (0) 7 4047 9150). You are correct that Australia is very strict about medical sign-offs. I was initially told by the cruise director that my U.S. doctor's signature was not sufficient and that I had to have an Australian doctor's signature. There was a lot of discussion and some phone calls were made and then I was told my PADI form was sufficient. The Emperor website states: "All diving guests joining an Emperor Divers' liveaboard are required to sign a self-declaration medical." This form lists the same medical conditions on the PADI form and had a statement at the bottom stating" I hereby confirm that I ________ have read through the various medical conditions listed above and to the best of my knowledge do not have a current or previous medical condition such as these that may affect my diving. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition." When I marked "yes" next to the hash-marks on the form, a member of the crew asked to see my medical release from my doctor. I showed it to him and then he marked on the self-declaration form that the release had been reviewed. He then returned the document back to me. On the Cat Ppalu trip, you sit down with a member of the diving crew who asks to see your c-cards and also personally asked if I had any medical conditions. When I answered yes, he asked for my medical release which I provided. I also remember this to be what happened on the Royal Evolution, e.g., a crew member asked about any medical conditions and then I had to provide my medical release. The medical releases were definitely required by the Spirit of Freedom and the Emperor boats. The releases on the Cat Ppalu and Royal Evolution were only asked from after a crew member asked me questions.I think you may be mistaking the form being "available" for it being required in some cases. I know that the form is required if taking courses with them, but I don't think it's necessary if you aren't doing any courses for most boats (the Emperor's website specifically calls the form out for "If you are doing a course" as do the All Star Liveaboards - including the Cat Ppalu). I'd be very surprised if any boats not around Australia (very strict, relatively, on their medical sign-offs) actually required it.