I acknowledge my informed consent to receive services that will be provided by Blue Zone Health and Hyperbarics, LLC (hereafter referred to as Blue Zone).
I hereby release Blue Zone, and their staff, associated health professionals, affiliates, and agents from claims and liabilities arising from the use of mild hyperbaric oxygen therapy. I hereby grant permission to Blue Zone to provide me with mild hyperbaric therapy. I also acknowledge that Blue Zone does not claim to prevent, treat, nor cure any condition or provide care, diagnosis, or rehabilitation to individuals, nor do they or their staff, associated health professionals, affiliates, and agents apply medical, mental health or human development principles, but rather provide wellness services, including mild hyperbaric oxygen therapy, that may benefit me.
I understand that Blue Zone and their staff, affiliates, and agents are not health care providers and services are not offered in a health care setting.
I have read, fully understand, and consent to any services provided. I have also completed the health questionnaire to the best of my ability, which accompanies this consent form. I agree to hold Blue Zone or their staff, associated health professionals, affiliates, and agents harmless from any blame or issues that may result from services provided by Blue Zone. Blue Zone, their staff, and/or agents are also not responsible for any harm that may come to accompanying children or animals that enter the machine.