Hyperbaric Oxygen Safety Screening

“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. 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 understand that not all California hyperbaric centers will accept the signed statement from Naturopath so I will check with my center and their medical screening process.
• I will take the physician statement along with the full report for final approval and signature from my doctor
• 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.