Forms – Hyperbaric Health & Wellness Foundation

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new patient intake form

*A prescription is required before treatment

We use 100% pure oxygen which is considered a drug and must be prescribed by a medical physician.

Patient's Name(Required)

First Last

Email(Required)

Phone(Required)

Date of birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please tell us about yourself.(Required)

All content is confidential

ABOUT US

A hyperbaric oxygen chamber is a medical device used to deliver high concentrations of oxygen to patients within a pressurized environment. This therapy, known as hyperbaric oxygen therapy (HBOT), involves breathing pure oxygen in a chamber where the air pressure is increased to three times higher than normal atmospheric pressure.

new patient intake form

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