Step 1Intake
Step 2Session
Step 3Protocol
Step 4Transition
Section A — Experience & background
1. Client name
2. Have you done HBOT before?
Yes, I have
No, first time
Not sure / heard about it
3. What brings you in today?
Select all that apply
Athletic recovery
Post-surgery support
Concussion / head injury
Brain clarity & focus
Anti-aging & longevity
Chronic fatigue & energy
Inflammation & pain relief
General wellness
4. How long has this been affecting you?
5. How is this affecting your day-to-day life?
6. What does success look like for you?
7. Timeline or upcoming event?
8. How active are you?
Section B — Safety screening
"I just need to run through a few quick safety questions — totally routine."
Have you ever had a collapsed lung?
Yes
No
Not sure
Safety flag. Physician clearance or signed waiver required.
Any current cold, sinus congestion, or nasal difficulty?
Yes, currently
No, feeling clear
Mild / allergies
Safety flag. Consider rescheduling or proceed with caution.
Staff note. Monitor ear pressure during session.
Ear surgeries or difficulty equalizing ear pressure?
Yes
No
Not sure
Safety flag. Physician clearance or waiver required.
Additional staff notes (optional)
Client records
All intake forms and protocols saved to this device
← Back to records
Intake summary
Original protocol
Check-in tracker
Select which session numbers to use as check-in milestones for this client based on their protocol length.
Tip: 5 sessions → check-in at 3. 10 sessions → 5 & 10. 20 sessions → 5, 10, 20. 40 sessions → 10, 20, 40.
Session check-in
How is the client responding? Select all that apply and add any notes.
Positive responses Neutral / mixed ConcernsUpdated wellness protocol