Shower off all lotions, make-up, powder, deodorant.
 Shampoo hair, but use no conditioner.
 Wear all cotton clothing, including underwear and/or diapers.
 Wear no metal of any kind (no jewelry, watches)
 Wear no nail polish, hair clips, dentures, hearing aids, contact lenses.
 No Depends or plastic diapers. Tampons are permitted.
 Patients should take regular medications, such as insulin, but no medicinal patches.
 If patient has a fever, they must reschedule.
 Patients should have no carbonated drinks, alcohol, caffeine, or foods causing flatulence (such as beans) 24 hours before dive, as they can cause discomfort and/or interfere with treatment.
 No food or drinks are allowed, except as provided by the Center, which is supplied in an acceptable container.
 Hand warmers, chemical heat pads, nicotine or other patches, cigarettes and lighters arestrictly prohibited, due to flammability.
 No BOOKS, No IPODS. NO Gameboys. No toys.
 Patients are asked to stop smoking before treatment, as smoking interferes with the body’sability to absorb oxygen. HBOT will assist in removing chemical toxins from smoking thataccumulate in the body.

 

*** DIABETICS: During a treatment, blood sugar may drop as much as fifty (50) points. It isimportant that you eat prior to your scheduled visit. Please advise our technician if you experiencesymptoms of low blood sugar. ***

I have read and agree to abide by this checklist for the safety of myself and the Clinic.

 

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Patient/Caregiver Signature Date

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