Please complete the following information prior to commencing an AirPod™ therapy.

HOW WOULD YOU LIKE US TO SEND YOU APPOINTMENT REMINDERS?
Do you have any difficulties clearing your ears when swimming or flying?
Do you have a pacemaker? (The AirPod does not affect the operation of this device.)
Are you pregnant?
Do you have a head cold, sinus or other condition that makes it difficult to equalise your ears?
Are you prone to experience seizures? Do you experience epileptic seizures?
Do you have, or suspect you have, a Pneumothorax (collapsed lung)?
Do you have compressive brain lesions or suspect that compressive brain lesions are an issue?
Do you have diabetes or are you Insulin dependent?
Do you suffer from claustrophobia or confinement anxiety?
Do you currently have a serious illness?
Are you sensitive to any chemicals or perfumes?
Are you a long term smoker?
Have you been diagnosed with emphysema?
Are you asthmatic?

The AirPod™ is not a medical device nor is it designed to treat medical conditions.
The following information is provided to assist you in determining if you can enjoy an AirPod therapy today

CONTRAINDICATIONS
The AirPod is NOT SAFE to use for people who are:
• pregnant
• under 12 years of age
• unable to clear ears due to otitis media, sinusitis or blocked nose (allergies, colds)
• under the influence of alcohol
• in a panic episode
• suffering from an infectious disease (i.e. tuberculosis, dysentery, etc) to avoid the spread of infectious pathogens

The AirPod MAY NOT be safe to use for people who are affected by the following:
• claustrophobia
• fitted with a pacemaker
• experience epilepsy
• suffering from serious illnesses – please consult your health practitioner before using this wellness device
• have a disease where pressurisation may have adverse effects – please consult your health practitioner
and advise you will be experiencing the same level of pressure change as you would in an aircraft

HOW TO COMMUNICATE WITH OUR STAFF OR STOP AN AIRPOD SESSION DURING A THERAPY

BUTTON TO PRESS TO COMMUNICATE

BUTTON TO PRESS TO CHANGE THE TIME

BUTTON TO PRESS TO STOP THE THERAPY

BUTTON TO PRESS TO CHANGE THE SPEED

BUTTON TO PRESS TO CHANGE THE PRESSURE

OTIC BAROTRAUMA

  • You can assist the equalization process by yawning, chewing, swallowing, working your jaw side to side and up and down, turning the head side to side and ear to shoulder.
  • In general, doing whatever assists you being comfortable when taking off and landing in a plane may be most effective for you.
  • Continue to do this as needed for the duration of pressurization and depressurization.
  • When the AirPod reaches full pressure and again when the AirPod is at normal pressure, there should be no additional pressure in the ears.
  • If you are unable to equalize ear pressure, and if you experience pain in one or both ears, it is critical that you communicate any discomfort immediately to our staff.
    – We can make adjustments in the pressurization or depressurization process to eliminate discomfort.
    – If you are unable to equalize the pressure in your ears the visit will be immediately concluded.
    – If pain persists beyond the visit, we recommend that you consult your physician to alleviate the pain before another visit.

EAR, SINUS, THROAT CONGESTION, HEAD COLDS, VIRUS OR PRIOR TRAUMA TO THE EARS

  • You may consider rescheduling your visit in the AirPod if you are suffering from any of these conditions.
  • Discomfort from these conditions is less frequent but may occur.
  • If you are unable to equalize ear pressure, and if you experience pain in one or both ears,it is critical that you communicate any discomfort immediately to our staff.
    – We can make adjustments in the pressurization or depressurization process to eliminate discomfort.
    – If you are unable to equalize the pressure in your ears the visit will be immediately concluded.
    – If pain persists beyond the visit, we recommend that you consult your physician to alleviate the pain before another visit.

PULMONARY HYPEREXPANSION

  • This condition is very rare during AirPod treatments.
  • Holding your breath during decompression must be avoided as it could lead to expansion of the air in your lungs and damage to the lung tissues.
  • In the highly unlikely event of an unexpected rapid decompression, it is vital that you exhale immediately.

PREGNANCY

  •  High pressure oxygen therapy is not allowed during pregnancy.

SEIZURES

  • High pressure oxygen therapy is not associated with causing or inducing seizures.
  • If you are seizure prone, please ensure you make our staff aware prior to any visit.
  • If a seizure is experienced in our clinic, our procedure is to call emergency services, remove the patient from the chamber and make the individual as comfortable as possible

PNEUMOTHORAX

  • High pressure oxygen therapy is contraindicated for an existing pneumothorax (collapsed lung).
  • If you have a Pneumothorax or suspect that a Pneumothorax is an issue, you will NOT be able to use the AirPod until a clearance from your Physician is provided in writing.
  • If you have experienced a pneumothorax in the past and have already been “cleared from your doctor” to resume normal activity, please present a written confirmation from your Physician advising you are able to proceed with the AirPod Therapy.

COMPRESSIVE BRAIN LESIONS – SUBDURAL HEMATOMA, INTERCRANIAL HEMATOMA

  • High Pressure Oxygen Therapy is contraindicated for existing compressive brain lesions (subdural hematoma, intercranial hematoma).
  • If you have compressive brain Lesions or suspect that compressive brain lesions are an issue, you will not be able to use the AirPod until you receive clearance from your Physician.
  • If you have experienced compressive brain lesions in the past and have already been “cleared from your doctor”
    to resume normal activity, please provide a written confirmation from your Physician so thatyou can commence the AirPod therapy.

DIABETES / INSULIN DEPENDANT

  • Insulin dependency may result in a drop in blood sugar while in the chamber.
  • If you experience or anticipate this episode, immediately communicate to the staff so that your treatment can be stopped.
  • If you are insulin dependent, please ensure you:
    – Take a blood sugar reading prior to your treatment (if below 150, you must have a snack prior to treatment) and again after your treatment (if below 150, you must have a snack prior to leaving).
    – Take a protein bar, or item you use to manage this condition, into the chamber with you.

SENSITIVITY TO CHEMICALS (MCS) / ODORS / ALLERGY

  • Avoid wearing heavy colognes as the smells may linger in the chamber and have an adverse effect on another patient.
  • If you experience adverse sensitivity or have allergies that may become aggravated while in the chamber, please let our staff know prior to your visit, or as soon as possible when in the chamber, so we can take action to assure your comfort or conclude the session.
  • If your sensitivities persist, we recommend you consult your physician in order to alleviate the underlying condition before your next visit.

LIABILITY/MEDICAL RELEASE AND INDEMNIFICATION AGREEMENT

Disclaimer Clause

Although all care is taken and safety procedures are implemented beyond those of manufacturers standards, Ritual Cryotherapy, its employees, owners or agents are not responsible for any loss or damage suffered by or to any person resulting from, or related to the delivery of Cryotherapy.

By signing this form, I understand and agree that:

  1. This release is intended to discharge in advance Ritual Biohacking, its directors, officers, officials, employees, agents and volunteers from and against all liability arising out of or connected in any way with my participation in these activities. I am aware of the risks and hazards in participating in Cryotherapy, Sauna, CAROL Bike, Photobiomodulation and Whole Body Vibration as provided by Ritual Biohacking and acknowledge that participation is entirely voluntary. I understand that the use of Cryotherapy involves extremely cold conditions and that participation may involve risk of serious injury, illness, disability or death.
  1. Knowing the risks involved and the contraindications related, I nevertheless choose voluntarily to request permission to participate; I acknowledge being over 16 years of age and have read this Waiver Form and agree to be bound by this Release and Indemnity and accept the above Disclaimer Clause.
  1. I will indemnify and hold harmless Ritual Biohacking, its directors, owners, officers, officials, employees and volunteers from any loss, liability, damage, cost or expense, including litigation of any form, arising out of or connected in any manner with my participation in such activities;
  1. I am in good health, have no COVID symptoms or been exposed to possible COVID positive cases and have no physical condition expressed in the ‘Contraindications’ or otherwise which would preclude me from safely participating in such activities;
  1. I understand and agree that this release is intended to be as broad and inclusive as permitted under the law of the State in which it is executed and that if any portion of this Hold Harmless, Release and Indemnification Agreement should be determined to be invalid, it is my intent that the remaining provisions shall continue in full force and effect.
  1. I agree that the therapist has detailed the process in receiving Cryotherapy, Photobiomodulation and Whole Body Vibration and that I have been provided the opportunity to seek further advice or ask relevant questions or participate in discussion, prior to treatment.
  1. Ritual Biohacking reserves the right to refuse treatment of any persons under the influence of drugs or alcohol and anyone who presents with any of the contraindications listed above.