CLIENT REGISTRATION / MEDICAL FORM

Date of Birth

Hyperbaric's Time

anémie / anemia

diabète / diabetes

hypertension artérielle / high blood pressure

maladie coronarienne / coronary problems

chirurgie cardiaque (pace maker – pontage /

cardiac surgery (pace maker – bypass)

antécédent de crise cardiaque /

previous heart attack

angine / angina

pneumothorax (poumon affaissé) /

pneumothorax (collapsed lung)

emphysème / emphysema

asthme / asthma

autre problème pulmonaire connu/

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