Full Name *

Phone *

Email *

DOB *

Contridictions

Banned Items

GDPR *By ticking this box I agree;  I understand that mild hyperbaric oxygen therapy is not intended to diagnose, treat, cure, or prevent disease. In addition, I recognize that while mild hyperbaric oxygen therapy may enhance healing, it does not replace a health professional’s prescribed medications or recommended treatments.

GDPR *By ticking this box I agree;  I understand that mild hyperbaric oxygen therapy uses an increase in atmospheric pressure in a sealed chamber to allow the body to absorb more oxygen (approximately 91%) at a cellular level to promote healing and wellness. I understand that the amount of atmospheric pressure used is 1.5 absolute atmospheres.

GDPR *By ticking this box I agree;  I understand that as the chamber is pressurized and depressurized I may need to equalize the pressure in my ears to acclimate to the pressure changes and may experience “popping” in my ears. This is normal. If I am unable to equalize ear pressure and experience pain in one or both ears, I will immediately communicate the discomfort, so adjustments may be made to eliminate discomfort. If I am unable to equalize the pressure in my ears, the therapy session may be terminated.

GDPR *By ticking this box I agree;  I acknowledge that a Hyperbaric staff member is present to work with me to provide comfort in the event of any discomfort I may experience, but that the staff member may not be a trained health care worker. I understand that this is not a medical facility.

GDPR *By ticking this box I agree;  I am a consenting adult over the age of 18 and that I agree to enter (and/or permit my child to enter) the mild hyperbaric chamber of my own free will. I am entering the chamber at my own risk and without the coercion or sales pressure from any associate or employee.

GDPR *By ticking this box I agree;  Not to bring food or drink into the chamber. I understand that the exception to this rule is if I have diabetes, in which case I will bring an appropriate snack to each session in case my blood sugar drops during treatment.

GDPR *By ticking this box I agree;  I have read and understood the banned item list and contradictions to treatment. I guarantee I have no medical conditions or items on or in my persons that may make usage of this service dangerous.  I am not aware of any physical conditions of which I suffer or have that would or should preclude my undertaking this therapy. If I have any doubts, concerns, or questions, I will, prior to undertaking such therapy, see and obtain medical advice from a licensed physician. In addition, I understand that it is my sole responsibility to update staff regarding any changes to my medical status or medications each time I receive treatment.I understand that by signing this I am assuming any and all risks associated with the administration of mild-pressure hyperbaric oxygen chamber therapy.

GDPR *By Ticking this box I agree to; Follow the instructional of use on how to enter and exit the HBOT by the staff. I agree to confirm there is also a paper instructional clearly visible and understood by me before starting my session. 

GDPR *By ticking this box I agree;  I have answered all the fields above honestly and as correct as possible. I understand and agree with the privacy policy and terms and conditions of Westgate Health Club. I have seeked approval from a qualified GP or appropriate specialist before commencing any activities within the Westgate Health Club Facility.  I understand Westgate Health Club holds no responsibility for the use or maintenance of the Hyperbaric Chamber. 

Signature *

Register