Rental Initial Enquiry Form

Read about contraindications here: Certain conditions and medications automatically prevent HBOT use. Treatment is NOT appropriate for individuals where the following apply: COULD HAVE A LIST HERE MAYBE??

Yes = One or more of the above applies | No = none of the above apply

Yes No

more about the 'be aware if you are up the duff' COULD HAVE A LIST HERE MAYBE?? OK to proceed with your rental enquiry?

Yes No

This will be the 'Primary Contact' if additional users are added later

First name

Last name

Email address

Phone number

Each rental allows for up to 4 additional HBOT users. Their information wil be gathered in good time. Note: Additonal fees may apply

Pass rule: <= 4

Signature

Use the bordered frame/handle to scroll; sign inside the white box.

Please sign before submitting.

Rental Enquiry Screening Form

Screening Questionnaire