Initial Hyperbaric Form

Dear Patient,

I would like to personally thank you for choosing the Hyperbaric Centers of Chicago, and look forward to serving your medical needs.

Your adherence to the policies listed below as well as any sacrifices necessary on your part will be greatly appreciated by all. Listed below are a few clinic policies for all who enter the chambers, and some may require changes in your normal routine on the day of your appointment, and while you are here.

Please refrain from the use of the following scented personal care products:

• Hand soap or lotions with fragrance, perfume, scented hair products, etc.
• Please refrain from exposure to tobacco smoke.

Items not allowed in or near chambers, for your safety:

• Battery operated devices
• Deodorant, of any kind
• Friction Toys
• Hairspray
• Hair or Body Oil
• Jewelry
• Makeup or cosmetics
• Metal hair pins, clips, etc.
• Newspapers or magazine
• Open flames
• Shoes
• Silk, wool, or synthetic clothing

Please sign and date below that you have read the above information.