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Call Us At: 833-620-8100
Hyperbaric Oxygen NJ
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Waiver Form

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Name*
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Diabetes Status

Do you have diabetes?*
What do you take?*
Please enter a number from 0 to 100.

Pulmonary Lung Diagnosis

Have you ever been diagnosed with any lung/pulmonary fibrosis?*

Pregnancy status

Are you pregnant or think you could be?*

Ear History

Have you ever had ear problems?
Do you have problems with your ears when you fly?
Do you know how to equalize the pressure in your ears?

Medical Devices

I am voluntarily participating in hyperbaric oxygen therapy at my own risk. I am aware of the risks associated with participating in this activity.

I hereby release and forever discharge HBOT USA, their affiliates, managers, members agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned activity.
Consent*
Signature*
Are you interested in owning a hyperbaric chamber?
Would you like someone from our team to contact you and answer any questions regarding chamber pricing and/or our training courses and business coaching programs?

Call Us Today

Our professional staff is here to answer any questions or concerns you may have. Call: 833-620-8100

Hours Of Operation

Mon-Fri: 9am-7pm
Sat: 9am-2pm

HBOT USA

17 Hanover Rd #300
Florham Park, NJ 07932

833-620-8100
support@hbotusa.com

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