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Registration

To Be Announced

The 'Ocean Hyperbaric Neurologic Center' team will be visiting Milano, Italy. We will be meeting with and reviewing the medical information of prospective patients, to aid them in their pursuit of excellent hyperbaric medical care:

- 30 min interviews, where patients and families meet one-to-one with one of our medical doctors.

- During interviews, patient medical history and information will be reviewed with the purpose of determining their candidacy for HBO treatment.

- Patients / clients will be able to speak with experienced medical personal to answer any questions they may have.

- Meetings are by appointment only. Please use the form below to register (we will promptly email appointment confirmation details to you). Please try to fill in the form completely, as it will help us greatly in preparing for your case.

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Date (Today):
Patient Last Name:
MI:
Patient First Name:
Referee:
Date of Birth:
Age:
Gender:	Male Female
Phone Number:
Email Address:
Address:
Parent / Carer 1 Name:
Parent / Carer 2 Name:
Chief Complaint:
History of Illness:
Current Medications:
Allergies:

 

 

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