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Soft Shell Hyperbaric Oxygen Therapy (HBOT) – 1.5 ATA

Multi-Session Informed Consent, Minor Consent & Liability Waiver

1. DESCRIPTION OF SERVICE

I understand that CryoFloat360 provides soft shell Hyperbaric Oxygen Therapy at approximately 1.5 ATA

The service includes

  • Entering a soft shell pressurized chamber
  • Gradual pressurization
  • Breathing oxygen-enriched air
  • Controlled depressurization before exiting

This is a wellness service and is not intended to diagnose, treat, cure, or prevent disease unless under physician supervision.

2. MULTI-SESSION ACKNOWLEDGMENT

I understand that this agreement applies to:

  • Single Session
  • Package of TBD Sessions
  • Monthly Membership
  • Ongoing Use Until Revoked in Writing

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Client Initials:



3. ENTRY & SAFETY INSTRUCTIONS ACKNOWLEDGMENT

I confirm I have been instructed on:

  • Proper chamber entry and positioning
  • Ear pressure equalization techniques
  • Communication with staff during treatment
  • Remaining calm during pressurization
  • Waiting for full depressurization before exiting

I understand:

  • I may not unzip or tamper with the chamber
  • The chamber must fully depressurize before opening
  • I must immediately report ear pain, chest discomfort, anxiety, dizziness, or distress

Failure to follow instructions may result in termination of the session without refund.

Client Initials: 


4. RISKS & SIDE EFFECTS

Possible risks include:

  • Ear barotrauma
  • Sinus pressure
  • Temporary vision changes
  • Fatigue
  • Claustrophobia
  • Lightheadedness
  • Oxygen sensitivity (rare at 1.5 ATA)

I understand improper pressure equalization may cause ear injury.

5. CONTRAINDICATIONS

I confirm the client does NOT have the following unless medically cleared:

  • Untreated pneumothorax
  • Severe COPD
  • Recent ear or chest surgery
  • Active ear infection
  • Uncontrolled seizures
  • High fever or contagious illness
  • Pregnancy without physician clearance

All medical conditions and medications have been disclosed.

6. FIRE & SOFT SHELL SAFETY RULES

I understand the following are NOT permitted inside the chamber:

  • Lighters or ignition sources
  • Electronics unless approved
  • Oils or petroleum-based products
  • Unauthorized fabrics or blankets

I agree to comply with clothing and safety guidelines.

Client Initials:


Date: June 18, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
I understand that this agreement applies to:
Single Session
Package of ______ Sessions
Monthly Membership
Ongoing Use Until Revoked in Writing
If, Package of ______ Sessions

I acknowledge that this waiver covers all current and future HBOT sessions at CryoFloat360 unless revoked in writing.

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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