Formulaire d'inscription pour les enfants

Date of Birth

Medical History

This medical evaluation is used to acquire pertinent medical information and determine that there are no contraindications before you undergo ¨HBOT¨ Hyperbaric Oxygen Therapy.

ATTENTION!

Please inform the technician if you plan to fly or visit the mountains during the period of your HBOT sessions.

ACCOMPANYING PERSON MEDICAL EVALUATION FORM

This for is for adults accompanying their children. If it does not apply, please disregard.

Consent Form

I hereby acknowledge having received a full explanation of hyperbaric oxygen therapy, the risks, effects and consequences and acknowledge having been encouraged to ask any and all questions related to this matter. At the same time, I acknowledge that no promise or guarantee whatsoever was made with regards to the results of receiving this therapy. I am also aware that hyperbaric oxygen therapy has not yet accepted by mainstream medicine for many disorders. Note: I accept and acknowledge that there are no physicians in that facility.

*

As a parent and/or legal guardian, I consent to the administration of hyperbaric oxygen therapy

I consent to receive hyperbaric oxygen therapy sessions

*

I have read and agree to abide by this checklist for the safety of myself and the clinic.

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