HBOT Consent & Liability Waiver
1. Introduction & Acknowledgment of Risks
Hyperbaric Oxygen Therapy (HBOT) involves breathing 100% oxygen at pressures greater than sea level in a specialized chamber. Potential risks include, but are not limited to: ear/sinus barotrauma, oxygen toxicity (seizures), temporary vision changes, claustrophobia, lung barotrauma, fire hazard, and other unforeseen complications.
By signing this Consent & Liability Waiver, You acknowledge and agree to the following:
2. Representation of Truthful Disclosure
You have completed the medical history screening honestly, including disclosing any:
- Lung conditions (e.g., pneumothorax, emphysema).
- Seizure or convulsion history.
- Pacemaker or other implanted medical devices.
- Recent surgeries, head injuries, pregnancy, or other conditions.
- Medications taken (including specific chemotherapeutic agents).
You understand that withholding or falsifying medical information increases the risk of serious injury or death and you assume all liability for such withholding.
3. Voluntary Participation & No Guarantees
You voluntarily agree to undergo HBOT. You understand that iCancierge makes no guarantees regarding symptom improvement, cure, or specific health outcomes.
4. Assumption of Risk
By proceeding, You assume all inherent and potential risks associated with HBOT, known or unknown, even if iCancierge or its staff fail to identify or disclose such risks.
5. Waiver & Release of Liability
TO THE FULLEST EXTENT PERMITTED BY LAW, YOU HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE iCANCIERGE, ITS OFFICERS, DIRECTORS, EMPLOYEES, CONTRACTORS, AGENTS, AFFILIATES, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, “RELEASED PARTIES”) FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, ACTIONS, OR CAUSES OF ACTION WHATSOEVER ARISING OUT OF OR RELATED TO ANY LOSS, DAMAGE, INJURY, OR DEATH THAT MAY BE SUSTAINED BY YOU, OR ANY LOSS OR DAMAGE TO PROPERTY, WHETHER CAUSED BY NEGLIGENCE OF RELEASED PARTIES OR OTHERWISE, WHILE PARTICIPATING IN HBOT OR ANY OTHER SERVICE PROVIDED BY ICANCIERGE.
Indemnification: You agree to indemnify and hold harmless Released Parties from and against any and all claims, liabilities, damages, losses, or expenses (including attorneys’ fees) arising out of or connected with Your participation in HBOT or other services, including but not limited to claims related to Your own negligence or willful misconduct.
6. Compliance with Instructions
You agree to follow all verbal and written instructions provided by iCancierge staff. Failure to do so may result in termination of treatment without refund.
7. Emergency Situations
In the event of an emergency, iCancierge will attempt to contact the emergency contact provided by You. You authorize iCancierge and its staff to seek medical treatment on your behalf if you are unable to do so. All costs incurred for such emergency treatment are Your responsibility
8. No Medical Relationship Established
By signing this document, no physician-patient relationship is created between You and iCancierge. You understand and agree that iCancierge is not providing medical diagnosis or treatment, and this Waiver is separate from any medical advice you may receive from your healthcare provider.
9. Governing Law & Dispute Resolution
This Waiver shall be governed by the laws of the State of California. Any dispute arising out of or related to this Waiver shall be resolved exclusively in the state or federal courts in San Diego County, California.
10. Acknowledgment of Understanding
You acknowledge that You have read this Consent & Liability Waiver, fully understand its terms, and sign it freely, voluntarily, and without any inducement. You understand that by signing, You give up substantial rights, including Your right to sue iCancierge.