“O2 Providers” is part of Wellness Without Limits LLC, a Florida
based company. Zayd Ratansi, ND serves as the hyperbaric advisor and
all other O2 Providers are independent healthcare practitioners
trained in hyperbaric therapy.
Safety Screening Report
By choosing the safety screening report then:
- I understand that this report is a “general risk assessment report”
for hyperbaric oxygen therapy and the results of this report are
solely based on my answers to the hyperbaric screening
questionnaire on the online intake form.
- I have accurately and to the best of my knowledge filled out the
Intake Form for the hyperbaric screening online application.
- I understand that this report is not a prescription and will
not be signed by an O2 provider. If I wish to proceed with
hyperbaric therapy, then I will take this report to my doctor and
get him/her to sign the physician statement before I begin
hyperbaric therapy.
Professional assessment — From an O2 Provider
O2 providers are independent licensed healthcare practitioners trained
in hyperbaric therapy and an O2 provider may or may not call you if
they have questions based on these answers. If I choose to have an
O2 provider review my screening report and give their professional
assessment of my fitness for undergoing hyperbaric therapy then:
- I understand that this is a “assessment for hyperbaric fitness” and
the results of this assessment are solely based on my answers to the
hyperbaric screening questionnaire on the online intake form.
- I have recently been evaluated within the past 6 months by a
licensed medical doctor for my health (and have not had any
changes in my health status since this evaluation) and have
accurately filled out any diagnosis of any medical condition or any
medication that I have been prescribed and made this aware and in
detail during this screening process. This includes any changes in
health or medication status since my last doctors visit.
- Since both past and current medical history are pertinent and of
primary importance to proper safety screening, I hereby agree that I
will accurately disclose all truthful information to O2 Providers
and hold harmless Wellness Without Limits LLC, Dr. Ratansi ND and
all O2 providers should I fail to provide necessary information for
safe and proper administration. “Necessary information” includes,
but is not limited to, any safety screening medications, controlled
substances, alcohol, homeopathic remedies, vitamins, and any other
over-the-counter items that I am currently taking that could affect
my sessions inside the chamber.
- If I am assessed for being “fit” to be inside a hyperbaric chamber
by an O2 provider, then I agree to immediately let my current
physician know and get their recommendation before proceeding
- If I am using this assessment for:
- General Health and Wellness, then I understand that
it is only to try to help me to improve my physiologically
available levels of oxygen, with the primary goal to help
support my body for optimal cellular functioning.
- A Medical condition, then I will first take this
assessment, along with the full safety screening report, to
my doctor so that he/she can sign the physician statement on
the last page of the safety screening report.
Physician Statement — From an O2 Provider
At this time, only Dr Ratansi, ND will be providing consultations for
signed Physician Statements (for hyperbaric approvals). If I choose
to have a hyperbaric consultation with Dr. Ratansi to sign my
paperwork then:
- I understand that this will be a Telehealth consultation and will
not be seeing Dr. Ratansi in person and the paperwork will be from
Dr. Ratansi’s Naturopathic License in the state of California.
- I have recently been evaluated within the past 6 months by a
licensed medical doctor for my health (and have not had any changes
in my health status since this evaluation) and have accurately
filled out any diagnosis of any medical condition or any medication
that I have been prescribed and made this aware and in detail during
this screening process. This includes any changes in health or
medication status since my last doctors visit.
- Since both past and current medical history are pertinent and of
primary importance to proper safety screening, I hereby agree that I
will accurately disclose all truthful information to O2 Providers
and hold harmless Wellness Without Limits LLC, Dr. Ratansi ND and
all O2 providers should I fail to provide necessary information for
safe and proper administration. “Necessary information” includes,
but is not limited to, any safety screening medications, controlled
substances, alcohol, homeopathic remedies, vitamins, and any other
over-the-counter items that I am currently taking that could affect
my sessions inside the chamber.
- If I am using this physician statement for:
- General Health and Wellness, then I understand that
it is only to try to help me to improve my physiologically
available levels of oxygen, with the primary goal to help
support my body for optimal cellular functioning.
- A Medical condition, then I will first take this
signed document, along with the full safety screening
report, to my doctor so that he/she can make a final
approval.