Hyperbaric Chamber Policies

OUR POLICIES

By signing this form, I acknowledge that, with respect to services rendered by Heavenly Salt Therapy, and their employees and agents, I understand the following: 

• In consideration for people who are waiting for appointments, we appreciate 24-hour notice of cancellation. We will charge you up to the full appointment fee for appointments that are missed or canceled within 24 hours.  

  Initial Here

• We encourage you to arrive a few minutes early for your scheduled appointment. If you arrive late, we may need to shorten your session. A shortened session will be charged the full fee. 

  Initial Here

• We are an out-of-network provider for services within this practice; We do not participate in any insurance panels, and do not accept assignment from any insurance company. Consequently, you are responsible for payment in full at time of service and charges are determined by us.

  Initial Here

• Wear comfortable clothing, preferably cotton or cotton blend.

  Initial Here

• Inform us of changes in your medications and medical status.

  Initial Here

• Empty your bladder immediately prior to your session to avoid discomfort.

  Initial Here

For Hyperbaric Chamber Use: 

• No food or drinks allowed in the chamber. However, if you have diabetes or are hypoglycemic, please bring a snack in case your blood sugar drops during treatment.

  Initial Here

• No flammables or sharp items are allowed inside the chamber (knives, keys, etc…). 

  Initial Here

• Due to the sensitivity of other patients and staff, refrain from wearing perfume, after-shave, or essential oils.

  Initial Here

• Please do not consume caffeine or carbonated beverages for at least 4 hours prior to your session.

  Initial Here

• You will not be allowed in if you smell of tobacco or cannabis smoke. It is recommended that you do not smoke or use tobacco products for 3 days prior to a treatment. Nicotine, a byproduct of cigarette and cigar smoke, causes constriction of blood vessels and HBOT stimulates the growth of blood vessels. Smoking during a course of therapy would counteract the beneficial effects of treatment.

  Initial Here

I have carefully read this form, which is printed in English, and acknowledge that English is a language I read and understand, and that I understand the form.  I do not feel rushed or impaired, nor am I under the influence of a sedative or sleep-inducing medication.

I accept and agree to all of the terms above.  I am free to refuse or withdraw my consent and to discontinue participation in any treatment, service, or research at any time without fear of reprisal against or prejudice to me. No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. I may request and receive a copy of this form from the Practice.  If any portion of this form is held invalid, the rest of the document will continue in full force and effect.