top of page

Hyperbaric Oxygen Therapy (HBOT) Checklist


HBOT has been reported to have beneficial effects for a wide range of conditions without negative side effects. Nevertheless, you should be aware of areas of concern. Please read the following information carefully before doing any treatments. (PDF Download Available) Note: All fields and questions must be complete and/or answered.

1. Otic Barotrauma (injury to the eardrum), Ear Pressure
Yes
No

(Patient can be taught to equalize pressure in the ears to reduce pain. If unable to equalize the ear pressure, treatment will be terminated) (Download Form)


2. Colds, Flu, Sinus and/or Throat Congestion, Coughing, Virus Infection, etc.
Yes
No

(Consider rescheduling treatment. Lungs, throat and nose must be clear before treatment. If problems arise during treatment, please communicate with staff to terminate session.) (Download Form)


3. Pneumothorax (collapsed lung), Pneumo-mediastinum (fluid in lungs)
Yes
No

(Medical doctor's written clearance needed)(Download Form)


4. Pneumonia, Emphysema and/or any other air-trapped illness evidenced by an air bronchogram.
Yes
No

(Medical doctor's written clearance needed that lungs are clear before treatment) (Download Form)


5. Drug Abuse or other Intoxications such as Alcohol, Smoking, etc.)
Yes
No

(Medical doctor's written clearance needed) (Download Form)


6. Compressive Brain Lesions such as Subdural Hematoma or Intercranial Hematoma.
Yes
No

(Medical doctor's written clearance needed)(Download Form)


7. Diabetes with tendency toward Hypoglycemia.
Yes
No

(Eat 2 hours before treatment. Take blood sugar level prior to treatment to avoid low blood sugar) (Download Form)


8. Claustrophobia
Yes
No

(Pressure & time will be increased slowly. May require a tender in the chamber) (Download Form)


9. Behavior Disorder 
Yes
No

(Patient may require a tender in the chamber)(Download Form)


10. Pregnancy
Yes
No

Not allowed during First Trimester. (For remainder of pregnancy, must have medical doctor’s written clearance) (Download Form)


11. Pulmonary Hyper expansion
Yes
No

Do Not Hold Your Breath during Decompression

(This condition is very rare during treatments in the chamber) (Download Form)


12. Sensitivity to Chemicals (MCS), Odors, Allergy.
Yes
No

(Avoid wearing heavy perfumes or colognes, as smells may linger & have adverse effect on others) (Download Form)


Hyperbaric Therapy may assist the body to naturally detoxify and balance digestive flora. An individual may experience some discomfort from this process after treatment.


Symptoms include: loss of appetite, stomachache, constipation, diarrhea, headache, flu-like symptoms, behavioral issues, etc.


Although unpleasant, this is a natural process, and continuing treatments may be of benefit to more rapidly accomplish a positive result.


However, if the symptoms persist, please consult Dr. Hardoon Office to evaluate and alleviate the situation before attempting another visit.


Also, if you answered "YES" to any of the above questions, please consult Dr. Hardoon Office.


Please be advised that if any discomfort occurs while in the hyperbaric chamber, the patient must call for staff to come and terminate the treatment session.


The patient may be advised to consult their own medical physician to evaluate the situation before attempting another visit.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Digital Signature required. (patient / parent or guardian for minor)

Today's date

bottom of page