Important things to know regarding your oxygen therapy treatment:

• Comfortable clothing is recommended (sweats, pajamas, leggings, shorts)
• Do not wear shoes inside the chamber, socks are recommended
• Feel free to bring a book, electronic tablet or cell phone into the chamber 

**Please note: If you smoke, it is important that you do not smoke 2 hours prior to the treatment and 2 hours after the treatment

BEFORE AND AFTER YOUR HYPERBARIC TREATMENT

If you are receiving hyperbaric treatments, it is important to understand how to clear your ears.  While inside the chamber, you must help your ears to clear by equalizing the pressure you feel.

You can accomplish this 3 different ways:

•  Yawn and Swallow
•  Valsava (Pinch your nose closed & attempt to gently blow through the nose)
•  Wiggle your jaw repeatedly (Up & Down, Left to Right, or in a Circular motion)

*Clearing your ears must be repeated every time you feel pressure building in your ears. If your ear does not clear using these techniques you must knock on the chamber so we can stop for a moment and let your ears adjust to the pressure. If you do not, you may develop discomfort or pain. Hyperbaric treatments should be painless.

Your ears may do some funny things while you are undergoing treatments in the hyperbaric chamber. You may experience popping or crackling of the ears (especially during a yawn)

You may experience some of these symptoms at any point during or following your treatment. It is important to understand that it is ok if you experience some or all of these symptoms:

• A fullness feeling in the ear(s)
• May feel as though you have water in your ear(s)
• One or both of your ears may be plugged
• Inside your ear may feel tender

 Please help us to ensure that you have a comfortable experience in the chamber.  It is our privilege to be of service to you, your friends and family.  We strive to create a positive environment and experience and we will do all that we can in helping you receive the most therapeutic value out of your hyperbaric oxygen therapy experience.

 ***Please Read***

• If you have nasal congestion, sinus problems or a head cold on the day of your treatment, it is not recommended you receive Hyperbaric Oxygen Therapy on that day
• Avoid excessive perfumes or skin lotion
• Please empty all pockets before treatment Please wear socks
• You must wait 48 hours before going in the chamber if you have had any new dental work, especially
  fillings (this is to preserve the integrity of the fillings)
• You should not fly or go to increased altitudes within 12 hours of a hyperbaric oxygen therapy treatment

INFORMED CONSENT FOR HYPERBARIC OXYGEN TREATMENT

I hereby authorize O2 Be Well and its staff to treat me in the hyperbaric oxygen chamber and do all that is required as part of that therapy.

If any unforeseen conditions arise during the course of this treatment, I do hereby authorize and request the technician and his/her assistants to perform such additional procedures and/or to render such treatment as he/she may in his/her professional judgement deem necessary.

The technician/staff member had explained to me the general methods of the procedure and explained to me the special risks, contraindications, and consequences associated with hyperbaric oxygen therapy.

These include, but are not limited to:

• Barotrauma
• Pulmonary Over Pressure Syndrome
• Changes to My Visual Acuity
• Claustrophobia

The alternatives to this therapy have been explained and I have been informed that I can refuse treatment.  I understand and acknowledge that no guarantee or assurance has been made to me regarding the results or risks, and I assume such risk as explained to me and all risks in connection with use of such treatment.

I, the undersigned, certify that I have read this consent and fully understand its contents, and hereby consent and agree to the terms.

O2 Be Well Mobile Hyperbaric Oxygen Therapy

POLICY STATEMENT

Welcome to O2 Be Well Hyperbaric Oygen Therapy.  Please read and sign our policy statement below.  Our staff will be happy to assist you with any questions or concerns you may have.  We believe that a clear definition of our office policies will allow you, the patient, and O2 Be Well to concentrate on the most important thing  - Regaining and Maintaining your health.

CANCELLATION POLICY AND APPOINTMENT REMINDERS:

Appointments have been scheduled for your convenience.  We require a 24 hour notice for any cancelled or re-scheduled appointment.  Failure to show for an appointment without notification will result in a $40.00 charge.  If you are more than 30 minutes late, we will have to reschedule your appointment.  If you are up to 30 minutes late, the treatment time will be cut short equal to the reserved time for your spot so we can keep our commitments to our other scheduled customers.  If at any time during the session the technician is uncomfortable with your behavior during the sessions, the technician reserves the right to end the session and the time allotted will be billed to you.  

SINGLE TREATMENTS & PACKAGES:

If you purchase a package, the full package price is due at the first appointment.  We do not refund any unused or unscheduled appointments.  Packages expire in 6 months from the date of purchase.  Single treatments are paid for at the time of each appointment. Paid sessions cannot be gifted or given to any other person.

INSURANCE:

O2 Be Well does not accept insurance as payment and does not bill the patient's insurance company for payment.  Patient's are responsible for payment for hyperbaric therapy treatments.

PAYMENT TYPES ACCEPTED:

We accept cash, check, debit, credit, and Zelle as payment

WAIVER OF LIABILITY, PERSONAL INJURY, INDEMNIFICATION, AND MEDICAL RELEASE

Acknowledgment and Assumption of Risk:

I am aware of the dangers and the risks to my person and my property involved in the treatment of hyperbaric oxygen therapy by the "Company", O2 Be Well hyperbarics.

I understand that this treatment involves certain risks resulting from hyperbaric treatments as covered in the “Informed Consent for Hyperbaric Oxygen Treatment” that I have read, agreed to and signed. I also understand that there are potential risks of which I may not presently be aware. I recognize the importance and agree to fully comply with the precautions, policies, rules, and regulations, and any technician instructions regarding participation in this treatment.

I understand that the “Company” O2 Be Well does not insure participants in the above described treatments, and the Company has no responsibility or liability, including, but not limited to injury, negligence, trauma, equipment failure, safety hazards or property damage resulting from this treatment which is performed in a mobile unit.

I voluntarily elect to participate in this treatment with knowledge of the possible risks involved, and I hereby agree to accept and assume any and all risks of property damage, personal injury, or death. Waiver of Liability and Indemnification In consideration for being allowed to voluntarily participate in the above-referenced treatment, on behalf of myself, my personal representatives, heirs, next of kin, successors and assigns, I forever:

a) waive, release, and discharge O2 Be Well and Redline Athletics and its agencies, officers, technicians and employees from any and all negligence and liability for my death, disability, personal injury, property damages, property theft or claims of any nature which may hereafter accrue to me, and my estate as a direct or indirect result of my participation in the above referenced treatment; and b) agree to defend, indemnify, and hold harmless O2 Be Well hyperbarics and Redline Athletics, its agencies, officers, technicians and employees, from and against any and all claims of any nature including all costs, expenses and attorneys’ fees, which in any manner result from participant’s actions during this treatment I hereby consent to receive medical attention/treatment at my own cost which may be deemed advisable in the event of injury, accident or illness during this treatment given by the Company. This release, indemnification, and waiver shall be construed broadly to provide a release, indemnification, and waiver to the maximum extent permissible under applicable law.

I, the undersigned participant, affirm that I am at least 18 years of age (or Parent/Guardian thereof) and am freely signing this agreement. I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses, injuries or claims I may sustain as a result of my treatment by O2 Be Well hyperbarics. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect per Arbitration Agreement signed and agreed upon between me and the Company and agree to hold harmless Redline Athletics.

REDLINE ATHLETICS WAIVER

I, and/or the minor children identified above, each of whom are my children or minors for whom I am a legal guardian (each a “Participant” and collectively the “Participants”), desire to workout, practice, participate in classes, attend events, and /or engage in training programs or additional therapies offered (collectively “Center Programs”) at the Redline Athletics Center identified below (the “Center”).

In consideration for being allowed to use the Center, I acknowledge and agree, on my own behalf and on behalf of all Participants that:

• Participation in Center Programs involves risks of serious injury, including, but not limited to, paralysis, dismemberment, permanent disability, and death, as well as losses, monetary or otherwise, to my person and property. I understand that these injuries and losses can result not only from the actions, inactions, or negligence of me or a Participant, but also the actions, inactions, or negligence of the Center, its employees, coaches, agents, and owners; and other individuals participating in Center Programs.

• Participation in Center Programs includes the use of various types of equipment manufactured by third parties. We make no representations or warranties regarding the condition of any such equipment. Injuries and losses can result from the condition of the Center’s equipment.

• a Participant’s physical condition prior to participating in Center Programs may cause or result in injuries and losses. I have identified all of each Participant’s existing medical conditions below. I acknowledge that the Center is relying upon complete disclosure of medical conditions in allowing a Participant to participate in Center Programs.

• Participating in Center Programs includes possible exposure to communicable diseases including but not limited to COVID-19 and/or similar contagious diseases and viruses. The undersigned acknowledges that they are aware of the risks associated with the exposure to communicable diseases at the Center and/or in connection with Center Programs.

• I understand and appreciate the risks associated with baseball, softball, and related activities, including but not limited to use of batting cages and pitching machines. I am fully aware of the risk of injury involved, catastrophic injury, paralysis, even death as well as other damages and losses associated with participation in baseball and softball related activities.

I VOLUNTARILY ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURIES TO MYSELF OR A PARTICIPANT (INCLUDING, BUT NOT LIMITED TO, ILLNESS, DISEASE, PERSONAL INJURY, DISABILITY, DISMEMBERMENT, AND DEATH, AS WELL AS DAMAGES, LOSSES, CLAIMS, LIABILITY, OR EXPENSES, OF ANY KIND, THAT I OR A PARTICIPANT MAY INCUR IN CONNECTION WITH PARTICIPATION IN CENTER PROGRAMS (COLLECTIVELY “CLAIMS”) OR LOSSES INCURRED AS A RESULT THEREOF.

ON MY OWN BEHALF AND ON BEHALF OF THE PARTICIPANTS, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS THE CENTER, REDLINE ATHLETICS FRANCHISING, LLC AND THEIR RESPECTIVE OWNERS, PARENTS, AFFILIATES, SUBSIDIARIES, SUCCESSORS, PREDECESSORS, AGENTS, CONTRACTORS, COACHES, DIRECTORS, AND EMPLOYEES FROM ALL CLAIMS OF ANY KIND. I UNDERSTAND AND AGREE THAT THIS RELEASE INCLUDES CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE CENTER AND/OR REDLINE ATHLETICS FRANCHISING, LLC AND THEIR RESPECTIVE OWNERS, EMPLOYEES, COACHES, VOLUNTEERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES, ARISING FROM, IN WHOLE OR IN PART, ONE OR MORE CENTER PROGRAMS OR O2 BE WELL HYPERBARICS.

 
Standard Medical Release

I hereby consent to the Center and its employees, agents, coaches, and owners providing medical care (emergency or otherwise) necessary for the health and safety of the Participants and further authorize any hospital or doctor to render immediate care and treatment as might be required for the health and safety of a Participant.

Photograph and Video Release

This agreement confirms the agreement between you, the Center, and Redline Athletics Franchising LLC regarding each Participant’s participation in Center Programs and grants the Center and Redline Athletics Franchising, LLC the rights to use any photographs or videos (the “Property”) taken of me or any Participant in connection with the participation of

Participants in Center Programs. I, on my own behalf and on behalf of each Participant irrevocably grant to the Center, O2 Be Well Hyperbarics and Redline Athletics Franchising LLC a perpetual, exclusive, irrevocable license to use the Property throughout the world in any medium (including print, digital, electronic, DVD, social media, internet and any other medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs or video footage taken of me and/or a Participant in connection with my participation in Center Programs. I will not bring or consent to others bringing a claim or action against the Center or Redline Athletics Franchising, LLC alleging that the Property, or in materials including the Property, is defamatory, reflects adversely on me, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. I hereby release the Center and Redline Athletics Franchising LLC, and their respective directors, officers, successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever relating to the Center and/or Redline Athletics Franchising, LLC’s use of the Property in a manner consistent with this Agreement.

This voluntary waiver and release from liability agreement is to be interpreted consistent with the laws of this State. I have read this voluntary waiver and release from liability agreement. I understand that I have given up substantial rights by signing it and I am signing this waiver and release from liability agreement voluntarily for myself and my children.

By my signature below, I confirm that I have provided all necessary contact information and relevant medical information regarding the Participants. I understand that I have a continuing obligation to update this information with the Center as new information becomes known by me. I will promptly update this information with the Center upon the discovery of new medical information and/or new contact information.

* By signing, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By signing here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

ARBITRATION AGREEMENT

Article 1  It is understood that any dispute or claim against O2 Be Well and/or the technicians and/orthe "Clinic" as defined herein whether for malpractice of any kind, and any other claims of any nature whatsoever including, but not limited to, any type of contract, that were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, action or inaction, failure to act, will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court process except as California law provides for judicial review of arbitration proceedings.
Both parties to this contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead areaccepting the use of arbitration.

Article 2  (a) The term "Patient" as used in this Agreement includes the undersigned individual, his or her spouse, children (whether born or unborn), and heirs, assigns, or personal representatives. The individual signing this Agreement signs it on behalf of the foregoing persons, and intends to bind each professional corporation or partnership, all independent contractors who practice or provide service for O2 Be Well, all employees, representatives, agents, directors, officers and assignees of O2 Be Well and Redline Athletics, and any employees, agents, successors-in-interest, heirs and assigns of the foregoing individuals or entities.(b) Actions Covered. Patient understands and agrees that any dispute of the sort described in Article 1 between Clinic (O2 Be Well and Redline Athletics) and Patient will be subject to compulsory binding arbitration. (c) Other Doctors, Medical Professionals, Service Providers, or Care Professionals. Patient understands that he or she may at times receive treatment from one or more technicians. Medical Professional, Service Providers, or other type of Care Professional who are independent contractors practicing or providing services at the same facility at Redline Athletics/ O2 Be Well. It is understood and agreed that any dispute of the sort described in Article 1 between Patient and such providers providing any type of service at the same facility and/or O2 Be Well will be subject to compulsory,binding arbitration. (d) Right of Action Waived. Patient understands that a claim shall be waived and forever barred if(1) on the date notice thereof is received, the claim, if asserted in civil action, would be barred by the applicable California statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein.

Article 3  (a) Informal Resolution of Disputes.  In the event Patient feels that a problem has arisen in connection with the care rendered by O2 Be Well and/or Clinic and/ or technician to Patient, Patient will promptly notify O2 Be Well and/or Clinic and/or technician so that O2 Be Well may have theopportunity to resolve the matter. (b) Method of Initiating Arbitration. If the dispute is not resolved by mutual agreement, Patient shall notify O2 Be Well in writing of his/her desire to arbitrate and shall designate an arbitrator. Within receipt of such notice, O2 Be Well and/or Clinic will designate an arbitrator to act on the parties & behalf in the even Patient actually files a claim for arbitration and pays the applicable required arbitration fees.(c) Applicable Law. The arbitration shall be conducted pursuant to the California Arbitration Act(C.C.P 1280-1295). The arbitrators shall, in addition, have authority to order such other discovery as they deem appropriate for a full and fair hearing of the case. A determination on the merits shall be rendered in accordance with the law of the Sate of California including the provisions of the medical injury Compensation Reform Act of 1975 which shall apply to the same extent as if thedispute were pending before a superior court of this State. (d) Interpretation of Agreement. Any controversy concerning the interpretation or application ofthe Agreement itself shall also be submitted to arbitration in the manner provided above.

Article 4 Revocation. If you sign this Agreement and then change your mind, the law permits you to revoke the Agreement, providing you give O2 Be Well written notice within 30 days from signing that you want to withdraw from the Agreement.
However, Clinic and Patient agree that any claim arising from services rendered prior to revocation shall be subject to arbitration. 

Article 5 Retroactive Effect: Also, by executing the agreement Patient agrees that this agreement covers ALL services rendered as defined in Article 1 before the date this agreement is signed whatever date the service was rendered.

Article 6 Invalid Provisions. If any provision of this arbitration agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision.

NOTICE:  BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ACTION OR REQUESTFOR DAMAGES DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL. SEE ARTICLE 1 OF THIS CONTRACT

 I understand that I have the right to receive a copy of this arbitration agreement.

We believe in the healing powers of oxygen!

It is our mission to help you heal faster and feel better. 

We can't wait to meet you

See you soon!