I hereby consent to participate in Hyperbaric Oxygen Therapy (HBOT) at Fusion Wellness. I understand that HBOT involves breathing concentrated oxygen in a pressurized chamber to enhance oxygen delivery throughout the body, promote recovery, and support various wellness and medical conditions.
I acknowledge that HBOT is generally safe when performed under controlled conditions but that potential risks and side effects can include ear or sinus discomfort, temporary vision changes, oxygen toxicity, barotrauma, or rare complications related to pressure changes. I understand that it is my responsibility to inform staff of any current health conditions, recent injuries, medications, or respiratory/ear/sinus issues before each session.
I have been informed that certain medical conditions — such as untreated pneumothorax, recent ear surgery, uncontrolled fever, certain lung diseases, or current upper respiratory infections — may preclude participation in HBOT. I agree to follow all safety instructions and to notify staff immediately if I experience any discomfort, pain, or unusual sensations during or after treatment.
I understand that HBOT is not intended to replace medical evaluation or treatment by my physician. I release Fusion Wellness, its staff, contractors, and affiliates from any and all liability related to participation in HBOT sessions, including but not limited to discomfort, side effects, or injury that may result from the use of the chamber or my failure to disclose relevant medical information.
I have had the opportunity to ask questions and have received satisfactory answers regarding the nature, purpose, risks, and potential benefits of HBOT. I voluntarily consent to undergo HBOT and acknowledge that I may discontinue a session at any time.
⚠ Important: Notify staff immediately if you experience ear pain, pressure, dizziness, shortness of breath, or any unusual sensations during your session. You may stop your session at any time.
Please sign below using your finger (mobile/tablet) or mouse (desktop):
Your information is kept strictly confidential and used solely for treatment purposes.