HBOT Intake Form

HBOT Intake Form

This intake form is collapsible for easy viewing. Hit the plus sign [+] next to the heading to open and close the form sections.

Please make sure all required fields are filled out or form will not submit upon clicking the submit button. May be easiest to fill out on a computer

Personal Information



Surgeries & Injuries

Personal Health History:


*These statements have not been evaluated by the Food and Drug Administration. *These services are not intended to diagnose, treat, cure, or prevent any disease. *If you have a suspected medical condition, see your primary care physician or go directly to urgent care if you suspect an emergency situation.

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