Intake Form

First, thank you for doing this with us. This form will only take a few minutes. Second, we're glad you found us - and hyperbaric oxygen, in general. We've been doing this for a long time (since 2006), and we've always been the advocate for the parent or the individual who is new to the hyperbaric oxygen landscape.

We train, educate, and provide services that bring awareness to hyperbarics, and our goals center around how we can build long-term relationships with like-minded folks like you.

Note: We are actively monitoring COVID-19 metrics and trends. Please complete your intake form, and know that we anticipate allowing few end-users per week into our facility, based on certain criteria. This means we will most likely slow the onboarding of new client-patients. However, if you are interested in a 'soft chamber' to use at home, this may be a suitable solution, depending on symptoms and conditions you intend to use HBOT for. Proceed as normal through this form, and we will respond within a day.

So, thank you for helping us spread the word and being open to using hyperbaric oxygen - whether at home or at our office in North Reading.

After you submit your form, we'll review the information and email you our Get Started email, which will have information that will help us both understand how to best proceed with helping you or your loved one. You can reach out to us at (978) 969-4095.

Name*

First Last

If referred by a friend or a practitioner, please let us know.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Best phone

For adult who will be doing HBOT, what is adult's age?

Are you the parent of a child who wishes to use HBO?*

Yes

What is your child's name?*

First Last

Child's age

How can HBO help?

What do you expect to improve upon, or get out of using HBO as a complement to your wellness plan?*

Please list your top 3 things you'd like to see improved. i.e. What are your main concerns right now? Note: Some folks, including many athletes, want to simply 'be healthier' and improve their immune system. Those can be top concerns, too.

Please list all medications you are taking or plan to take? (one per line)*

Conditions*

List all conditions or diagnoses

Who is your doctor and/or facility that you have an ongoing relationship with? Provide contact info, please, if you have it handy.*

Chances are, we're aware of the practice and the doctor. Also, if you suggest that we send their office some generic literature about what we do, we will! We appreciate you helping us spread the word.

Would you like to be added to the Hope Connection Newsletter?

Yes

Our newsletter is sent out once every two months and includes information about portable chamber solutions, pairing-and-sharing at Hope, and news about our non-profit partners.

Are you interested in learning about HBOT chambers for home use?

Yes

As experts in HBOT, we have navigated the landscape of hyperbarics and, specifically, mild HBOT chambers that can be installed at home or office. We service equipment and train users on their personal hyperbaric chambers. Home (or portable) units may be most suitable in cases where lower pressure, longer sessions, and more frequent usage has shown to be helpful; some conditions that we have found to fall into this category are: autism, post-concussion, early-stage Parkinson's, stroke recovery, post-stem cell surgery, and Lyme disease, among other cases. A note about portable, home units: These units do not provide 100% oxygen - but oxygen in the mid- to high-ninety percent, and in general these do not provide pressures higher than 1.30 ATA (atmospheres absolute), which is why these may not be suitable for everyone.

Hope Connection
21 Main Street, Suite 1C
North Reading, MA 01864
Office: (978) 664-8100

Monday: 9:00 am- 5:00 pm
Tuesday: 9:00 am- 5:00 pm
Wednesday: 9:00 am- 5:00 pm*
Thursday: 9:00 am- 5:00 pm
Friday: 9:00 am- 5:00 pm
Weekends: by appointment

* Tue, Wed, and Thu are our 'discount days,' when per-hour rates are only $125. (Like our Facebook page for pricing changes and other updates.)

In full support of the FDA, Hyperbaric Oxygen (HBO) for indications other than the 13 UHMS-approved indications is considered ‘off-label.’ The content and information provided on this website is for informational and educational purposes only. We encourage all to consult with their doctor before pursuing any form of medical treatment, including HBO. The information provided within this site is not to be considered medical advice. Please consult with your primary care doctor. Our staff doctor can work with your physician and current medical team.

HOPE uses 100% oxygen, mHBOT, and hard-steel mono- and multi-place chambers.

Intake Form

Intake Form

Getting To Know You

Your Wellness Program

How can HBO help?

Hope Health Newsletter

Success!

For Client-Patients

For Medical Professionals