Informed consent and clinical screening for hyperbaric oxygen therapy sessions, covering pressure physiology, fire hazard protocols, contraindications, ear and sinus equalization, and ESIGN acknowledgment.
The Hyperbaric Oxygen Therapy (HBOT) Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers hbot, hyperbaric, oxygen therapy, pressure, wound healing, consent. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Hyperbaric Oxygen Therapy (HBOT) Consent > **Important — not medical advice.** For use by a licensed/qualified provider; a thorough clinical screening including review of chest imaging, ear/sinus history, and current medications is mandatory before any HBOT session. HBOT is an FDA-cleared medical device treatment for specific indications; off-label use requires informed patient understanding of the evidence base. --- ## Facility & Patient Information **Facility Name:** ___________ **Supervising Provider / Medical Director:** ___________ **Session Date:** ___________ **Patient Full Name:** ___________ **Date of Birth:** ___________ **Phone Number:** ___________ **Email Address:** ___________ **Referring Physician (if applicable):** ___________ --- ## Treatment Details **Indication / Reason for Treatment:** ___________ **If off-label or other, describe:** ___________ **Chamber Type:** ___________ **Prescribed Pressure (ATA):** ___________ **Prescribed Session Duration (minutes):** ___________ **Number of Sessions Planned:** ___________