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Hyperbaric Oxygen Therapy (HBOT) Consent Form

NeoScience Hyperbaric Chamber 

I am voluntarily consenting to receive Hyperbaric Oxygen Therapy (HBOT) in a pressurized chamber at this facility. This therapy involves breathing concentrated oxygen while inside a chamber pressurized to 1.5 ATA (atmospheres absolute). It is a non-invasive wellness service designed to support recovery, performance, and overall well-being.

I understand that potential benefits of HBOT may include:

  • Boosted oxygen delivery to tissues for faster recovery
  • Reduced inflammation and support for cellular repair
  • Improved mental clarity and reduced brain fog
  • Enhanced energy levels and physical performance
  • Promotion of skin regeneration and collagen production

While many clients report positive outcomes, results vary by individual. No specific medical claims or guarantees are made regarding treatment outcomes.

Contraindications – I confirm that I do NOT have any of the following:

  • Pneumothorax (collapsed lung)
  • Uncontrolled asthma or recent asthma attack (unless cleared by my provider)
  • Ear infection or inability to equalize ear pressure
  • Vertigo or chronic dizziness
  • Severe COPD or emphysema
  • Fever (over 101°F) or active respiratory infection (including flu or COVID-19)
  • Pregnancy (unless cleared by my doctor)
  • Implanted devices not cleared for pressure, such as certain pacemakers, insulin pumps, or cochlear implants
  • Seizure disorder without current medical clearance
  • Claustrophobia that cannot be managed inside the chamber

If I have any questions about these conditions or am unsure, I will consult with my provider before beginning treatment.

Safety Guidelines – I agree to the following:

  • I will remain inside the chamber for the full session unless medically necessary to exit.
  • I may bring my phone inside but will not use headphones or laptops during the session.
  • I understand that ear pressure changes may occur during pressurization or depressurization, and I will notify staff if I am unable to equalize pressure.
  • I understand that if I feel discomfort or anxiety during the session, I may signal staff and they will assist promptly.
  • I have been advised that HBOT is a wellness therapy and not a substitute for medical treatment.

Consent & Acknowledgment

I have read and understand the nature of hyperbaric oxygen therapy and its potential risks and benefits. I understand that individual results are not guaranteed, and that this therapy is not intended to diagnose, treat, or cure any medical condition. I certify that I have disclosed all relevant health conditions, and I agree to inform staff of any changes to my medical status.

By signing below, I confirm that:

  • I am at least 18 years old and able to provide consent
  • I have had the opportunity to ask questions and all were answered to my satisfaction
  • I voluntarily assume all risks and agree to receive this therapy under the supervision of qualified staff


First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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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*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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