Please note all patients will be requested to sign below policies before starting treatment at NUMA.
Risks
Hyperbaric Oxygen Therapy (HBOT) is a painless non-invasive process. You should feel comfortable at all times during your treatment. If you do not, speak to the technician immediately.
Ears
If any, the most likely side-effect you may feel during your hyperbaric treatments is the pressure changes which affect your eardrum. Your technician will teach you the valsalva manoeuvre which is a technique that allows you to equalize the pressure in the middle ear and additional techniques which will help you throughout treatment. Any ear pain should be addressed immediately during treatment. Please discuss and notify any problems or concerns you may have with the technician.
Sinus
Sinus squeeze is very rare and is caused by changes in pressure. Pain may be felt around the sinus areas of the face. This usually occurs if the sinuses are blocked by mucus or tissue. Always inform the technician if you are uncomfortable or feel any pain immediately.
Other risks
Some mild physiological changes and symptoms may present themselves over the course of your treatments; some may be due to medication interactions. It is important that you advise your technician and physician if any of unfamiliar symptoms arise, including but not limited to:
Please notify us immediately if any of the above or any the following occurs during your course of treatment.
Please call us and reschedule your appointments if you develop colds, flu, upper respiratory infection, sinusitis, high fever, viral infection, vomiting, headache, or any other out-of-the-ordinary symptoms or concerns.
Please let us know if there is anything we can do, in order to ensure your time with us is comfortable and pleasant. If you have any concerns and/or develop problems with your health, call your GP/physician immediately and please inform us. We are here to help you get better.
Consent
I , _______________________________________________, hereby consent and authorize Numa Ltd staff to administer sessions of Hyperbaric Oxygen Therapy (HBOT) to me at the Hyperbaric Oxygen Clinic (Clinic). In doing so, I hereby fully understand and acknowledge the following:
I have received the approval of assigned medical consultant to receive HBOT. I was explained the possible benefits and risks of HBOT, including as relevant to my specific condition (if applicable). I acknowledge that the physician ultimately responsible for my care is my GP.
I understand that I am undergoing HBOT not for the purpose of Treatment of disease, disorder or injury. I understand that I am only using HBOT as an aid to improve my general wellbeing and/or assist healing. For this reason, the nature and purposes of HBOT have been explained to me, including the option not to have treatment.
I understand that for best results a full course of sessions should be completed.
I also understand that HBOT may need to be repeated in the future, either by repeated sets of treatment or by frequent maintenance treatments to help maintain its benefits.
Prior to any treatment, I have undergone an Initial Consultation and been given the opportunity to ask any questions I have regarding HBOT, and these have all been answered to my satisfaction. I have been informed that I may refuse treatments at any time, or even terminate a treatment whilst in the chamber, and exit the chamber in accordance with the instructions of the chamber operator.
Before my first treatment, I have informed the Clinic of my current health status, all current medications, and therapies, and I agree that it is my responsibility to keep the Clinic informed of any changes in my medical condition, medication or therapies before each session and I authorize the Clinic to contact my GP and other involved physicians and share my information if necessary.
I will follow the instructions of the chamber operator and I will inform them of any concerns before and during the treatment, such as pain, nausea, diarrhoea, dizziness, visual changes, ringing or other noises in ears, unusual smells, fear or anxiety reaction, unusual sweating, changes in heart rhythm, hiccups, chest pain, faintness, mood changes, difficulty breathing or any discomfort.
I understand that the benefits of HBOT may be much greater if I follow a healthy lifestyle, which includes non-smoking, weight control, exercise, proper nutrition and stress management.
I understand the risks and complications involved with this treatment can include and are not limited to the following:
Potential Risks of HBOT (more than 5%):
Uncommon Risks and Complications of HBOT (1-5%):
Rare Risks and Complications (less than 1%):
I believe the benefits from this treatment, exceed the risks involved.
No guarantee has been made that the treatment will improve my condition even though it has been carried out with due professional care. If any unforeseen conditions arise during the course of the treatment, I do hereby authorize/request the staff to perform any additional procedures and/or treatments as may be deemed necessary in that time.
PRINT NAME: ____________________________________
SIGNATURE: __________________
DATE: _____ / ______ / ______
PAYMENT TERMS AND CONDITIONS
You are purchasing a package of (insert number) hyperbaric oxygen therapy session(s). The price for such packages and individual sessions is set out in the price list accessible on our website or at the Clinic.
If you prefer, you can pay for each session individually on the day of treatment at the single session value of £160.00. If purchasing a package, the package needs to be paid in full before the first session of the package takes place.
Subject to the below, packages are non-transferable and non-refundable and if you decide not to proceed with your course of treatment, you will not be able to claim a refund for any sessions which have not been used.
If something in your medical condition changes, the Clinic (acting in its sole discretion) may need to postpone your treatment. In such circumstances, you shall be entitled to postpone any sessions remaining in your package until you are able to undergo treatment.
If we have to cancel any of your sessions and cannot offer you another session at a time that suits you, you will be entitled to a full refund in respect of that session.
Packages need to be used in full within 6 months from the purchase date. All sessions need to be pre-booked with the Clinic in advance.
You can change the time/and or date of your appointments (subject to availability) upon giving the clinic at least 48 hours’ notice of such change. Should you miss a session or change it with less than 48 hours to the planned start, one full session will be deducted from your pre-paid package, and if no sessions remain in credit, you will be charged for the value of one single session.
General Terms and Conditions
Preparing for Your Hyperbaric Oxygen Therapy
One of our main objectives is to inform you of what to expect during your hyperbaric treatments with us. Prior to any treatment session you will be asked to come in for an initial consultation for an assessment and taken through an orientation. The purpose of this consultation is to make sure you are suitable for HBOT treatment with a medical assessment and to answer any questions you may have. Please feel free to ask any questions, we are here to help you.
Children, family, friends, caretakers
In order to be able to provide efficient and safe monitoring during your treatment, we don’t allow any family members, friends, caretakers, or any other persons associated with the patient (“Associates”) in the clinic room (unless specifically authorized by a technician). Failure by you or any of your Associates to comply with this requirement or to follow the instructions of a technician when in the clinic room may result in the termination of your treatment for that day.
No child under the age of 14 years old is allowed in the treatment area.
Personal Items
For your safety and the safety of those around the chambers, only items approved by our technical team can be taken into the chamber with you. Each chamber is accommodated with a mattress, pillows and blankets.
NUMA Ltd and its staff members are not responsible for the loss of any your personal belongings.
Clothing
We advise loose-fitting cotton clothing, and avoid cosmetics, perfumes, hair sprays, deodorants and jewellery. Shoes must be removed, and socks must be worn inside chamber.
Food and drink
No food/eating is allowed in the chamber.
It is strongly recommended that you have a light meal one hour prior to your treatment and are well hydrated with water throughout the day. To obtain full benefit from your treatments, it is recommended that you avoid food and beverages that contain caffeine. Consumptions of coffee, tea and caffeinated drinks should be kept to a minimum during the time you are receiving treatment as caffeine constricts blood vessels. Also, alcoholic beverages should be avoided before treatments because of alcohol’s diuretic effect.
Smoking
Nicotine greatly compromises the effectiveness of your treatments and increase the risk of seizures. It constricts blood vessels which decreases blood flow to bone and tissue areas, thus slowing down the healing process by approximately thirty percent. Every attempt should be made to quit or temporarily stop smoking. If you must smoke, please do so as long before your treatment and as late after your treatment as possible.
Scheduling
Every attempt will be made to plan your treatments so that they fit your schedule. Once you have reserved your time slot, we try to keep it reserved for you for the duration of your treatment. If you are late, you are unable to come in, or we have an emergency patient, we may assign your time slot to another patient. Keep in mind that generally, time slots are on a first come first serve basis.
Please arrive 5 minutes prior to your scheduled treatment time in order to prepare for your treatment. Our daily treatment schedule runs smoothly if patients arrive on time. All appointments will start on time with no exception. If you are late, this time will be deducted from the remainder of your allocated session.
During your visit to the Hyperbaric Oxygen Clinic, we will gather personal and clinical information about you. Any information which you provide will be stored and processed in accordance with applicable data protection laws, including the General Data Protection Regulation and the Data Protection Act 2018. Detailed information about what information we collect about you and how we use that information is contained within our Privacy
Policy, which can be found at our website or obtained at the clinic by speaking to a member of reception for a paper copy.
Privacy Policy
Who we are:
NUMA Ltd (“we”, “us” or “our”) operate the Hyperbaric Oxygen Clinic (“Clinic”), which is a private clinic offering hyperbaric oxygen treatment. The Clinic is based at 58 South Molton Street, London, W1K 5SL.
The General Data Protection Regulation (GDPR) sets out the basis upon which an individual’s data can be obtained and used. The purpose of this Privacy Notice is to explain how we will use any personal data that we collect about you when you contact us or use our services.
If you would like to contact us about any of the information contained within this Privacy Notice you can contact us at [email protected] or telephone on +44 (0)20 3823 1212.
Information we collect about you:
Patients and Prospective Patients:
We collect information about you when you contact us about our services, make an appointment with us and visit the Clinic for treatment or are referred to us by another medical professional.
In order to support your care, our staff maintain records about you. This can include:
We also collect information about you when you complete our new patient questionnaire and patient satisfaction feedback questionnaire.
Website users:
When you use our website, we may also collect information about your visits to the website, and technical information about your computer, tablet, mobile or other device through which you access the website and/or platform.
How we will use your personal information:
We will use information about you to enable us to arrange appointments with our clinician and/or investigations or hyperbaric treatments to ensure that you are receiving care appropriate to your clinical needs.
We will use your information to provide you with details about other services or products that we offer that we think will be relevant to your ongoing care or of may be of interest to you.
If you are a website user, we will also use your personal data for the purposes of:
Marketing:
We would like to send you information about products and services of ours and other companies we work with which may be of interest to you. If you have consented to receive marketing you may opt out at a later date.
You have a right at any time to stop us from contacting you for marketing purposes. If you no longer wish to be contacted for marketing purposes, please [click on the unsubscribe options in our communication] or contact us using the details provided above.
Lawfulness of processing:
We are only allowed to process your personal data where we have a lawful basis for doing so. We will only process your personal data where:
Where we process your “special category data”, which is more sensitive personal information (such as health data) which benefits from a higher degree of protection under the GDPR, we only do so where:
When you come to the Clinic to obtain hyperbaric oxygen therapy and agree to the terms of our medical consent, we will process your health data as required in order to provide you with the health services you have requested.
If you would like more information in respect of the lawful bases upon which we are processing your personal data, please contact us using the details provided above.
Who we share your data with:
We will not disclose your personal data other than as set out in this privacy policy without your permission, unless in exceptional circumstances (i.e. life or death situations) or we are required to do so by law.
If you have been referred to us by another medical or allied professional, we may disclose details of your treatment and clinical progress to them where appropriate. We will discuss any disclosure with you in advance. You can ask for some information not to be shared but this may result in the delivery of your care being less efficient.
In order for us to provide our services, we may share your information with selected third parties including; clinical facilities, suppliers and sub-contractors.
We may share certain of your information with analytics and search engine providers that assist us in the improvement and optimization of our site.
We will share information about your treatment with us with your insurance company in line with the terms of the policy that you have in place with them.
We may share your data if all or substantially all of our assets are acquired by a third party, in which case personal information held by it about you will be one of the transferred assets.
Your Rights:
Access to your information:
You have the right to request a copy of the information that we hold about you (“Right of Access”). If you would like a copy of some, or all, of your personal information please contact us using the details set out above or write to us at the following address: 58 South Molton Street Clinic, London, W1K 5SL.
Right of rectification:
If your personal details change, or it comes to your attention that the information we hold about you is inaccurate in any way please let us know and we will make the appropriate corrections.
Right to Object:
You have the right to object to our processing of your personal information where:
Your other rights:
In certain circumstances, you may also have the right to:
Please note that the above rights are not absolute, and we may be entitled to refuse requests, wholly or partly, where exceptions under the applicable law apply.
If you have concerns about the way in which we have handled your data, please contact us using the details provided above.
Whilst we would welcome the opportunity to resolve any concerns you have in relation to our handling of your personal data in the first instance, you can also lodge a complaint at any time to the Information Commissioner’s Office at: https://ico.org.uk/concerns/.
Where we store your personal information:
Where we collect personal information from you, it may be necessary for us to transfer your personal information outside of the UK or the European Economic Area (“EEA”) to our service providers and business partners located outside the UK or the EEA.
Where personal information is transferred to and stored in a country not determined by the European Commission as providing adequate levels of protection for personal information, we take steps to provide appropriate safeguards to protect your personal information, including entering into standard contractual clauses approved by the UK or the European Commission, obliging recipients to protect your personal information.
Security:
When medical records are shared with third parties electronically, this is done through an encrypted file sharing service.
Unfortunately, the transmission of information via the internet is not completely secure. Although we will do our best to protect your personal data, we cannot guarantee the security of your data transmitted to our site; any transmission is at your own risk. Once we have received your information, we will use strict procedures and security features to try to prevent unauthorised access.
Cookies:
Our website uses cookies to distinguish you from other users of our website. A “cookie” is a small amount of data which often includes a unique identifier that is sent to your computer, tablet or mobile phone (referred to here as a “device”) browser from a website’s computer and is stored on your device’s hard drive, mobile or other device.
There are different types of cookies which are used to do different things such as allowing you to navigate between pages on a website efficiently, remembering your preferences on certain web pages, or improving your overall experience.
Most web browsers automatically accept cookies, but you can disable this function by changing your browser settings if you so wish. To find out more about cookies including what they are, how to control them or how to delete them, please visit www.aboutcookies.org.
We ask for your consent to place cookies on your device, except where these are essential for us to provide you with a service that you have requested.
Other websites:
Our site may, from time to time, contain links to and from the websites of our partner networks and affiliates. If you follow a link to any of these websites, please note that these websites have their own privacy policies and that we do not accept any responsibility or liability for these policies. Please check these policies before you submit any personal data to these websites
Data Retention:
We will only retain your personal data for as long as reasonably necessary to fulfil the purposes we collected it for, including for the purposes of satisfying any legal, regulatory, tax, accounting or reporting requirements. In general, health records of patients are kept for 8 years after conclusion of treatment (children’s records are to be retained until they are 21 years old). Other specialised categories of data are retained according to the NHS retention schedule.
Changes to our Privacy Notice:
We regularly review our Privacy Notice and will update this page when necessary. This Privacy Notice was last [ 11/07/2020 ].
Acknowledgement of Notice of Privacy Practices
“I hereby acknowledge that I have read and understood this clinic’s NOTICE OF PRIVACY PRACTICES. I understand that if I have questions or complaints regarding my privacy rights that I may contact the person listed above. I further understand that the clinic will offer me updates to this NOTICE OF PRIVACY PRACTICES should it be amended, modified, or changed in any way.”
Patient or Representative’s Name (please print)
Patient’s name:
I certify that the Patient Information is true and accurate. I will advise Hyperbaric Oxygen Clinic if there is any change in my patient information, medical problems, allergies, medications, medical history, insurance or financial information, or any other pertinent information pertaining to Hyperbaric Oxygen Therapy.
I have received the approval of assigned medical consultant to receive Hyperbaric Oxygen Therapy. I was explained the possible benefits and risks of Hyperbaric Oxygen Therapy. I acknowledge that the physician ultimately responsible for my care is my GP.
I understand that I am ultimately responsible for the cost of my Hyperbaric Oxygen Therapy. I understand that the payment is expected at the time of service. I will finalize my Patient Payment Terms and Conditions prior to starting treatment so that I fully understand my payment obligation for my therapy. I authorize payment of my treatment to the provider of Hyperbaric Oxygen Therapy. Because the cost per treatment may be different for other patients based on a number of factors, I agree to keep my payment agreement confidential and not disclose my treatment cost to patients, other persons or facilities. If I am being treated for a covered condition under an insurance plan, I will still be paying for my treatment in advance. But I will be provided by a receipt for reimbursement. I understand that Numa Ltd has no responsibility in the process of obtaining reimbursement. I authorize the payment for my Hyperbaric Oxygen Therapy.
I further authorize the release of any medical records or other information necessary for claim processing, on the request of physicians or providers involved in my care, and/or as required by law. Your overall health is important to us. We may need to inform your referring physician and other physicians involved in your care with your hyperbaric oxygen treatment progression. Please let us know if you would prefer your physicians and providers not be notified of your HBOT treatment.
Name
Signature
Date:
COVID-19 Self-declaration Questionnaire
The safety of our patients, employees, families and visitors remain NUMA’s top priority. We are continuously monitoring the changes and following the updated guidelines and recommendations by the government and NHS in providing healthcare service during COVID-19 pandemic.
We are conducting a short questionnaire in order to prevent spread of COVID-19 and reduce potential exposure to patients, employees, families and visitors. Your participation is paramount to help us take necessary measures protect you and everyone in this building. Thank you for your time.
Self-Declaration by Patient (please tick )
1. Have you returned from overseas within the last 28 days?
☐ YES
☐ NO
2. Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
☐ YES
☐ NO
3. Have you been in close contact with anyone who has travelled overseas within the last 14 days?
☐ YES
☐ NO
4. Have you experienced any cold or flu-like symptoms in the last 14 days including:
☐ fever
☐ persistent cough
☐ sore throat
☐ respiratory illness
☐ difficulty in breathing
☐ loss of taste
☐ loss of smell
lf the answer is ‘yes’ to any of the above questions access to the clinic will be denied.
High risk (please tick )
☐ had organ transplant
☐ having chemotherapy or antibody treatment for cancer, including immunotherapy
☐ having an intense course of radiotherapy
☐ having targeted cancer treatments (such as protein kinase inhibitors or PARP inhibitors)
☐ had blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
☐ had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
☐ has severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
☐ SCID (severe combined immunodeficiency) or sickle cell disease
high doses of steroids or immunosuppressant medicine.
☐ has a serious heart condition
☐ pregnant
Moderate risk (please tick )
☐ 70 or older
☐ mild asthma, COPD, emphysema or bronchitis
☐ heart disease (such as heart failure)
☐ diabetes
☐ chronic kidney disease
☐ liver disease (such as hepatitis)
☐ Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy
☐ on low doses of steroids
☐ significantly overweight (a BMI of 40 or above)
lf the answer is ‘yes’ to any of the above questions access to the clinic may be denied. This will be determined by our medical consultant.
By signing self-declaration, you are consenting to treatment at NUMA during a CoVlD- 19 Pandemic. Whilst every precaution will be taken to ensure your safety, you are agreeing to have treatments at NUMA entirely at your own risk.
I accept these terms and by signing below, l confirm that l shall have no COVID-19 related claims against Dr Nur Ozyilmaz and NUMA Ltd.
| Signature of the Patient | |
| Name of the Patient | |
| Date |
The information collected on this form will be used to determine your access and right to treatment at NUMA.
| Office Use | |
| Access to the clinic | DeniedApproved |
| Date |
Please note there are a few changes to the way we will be working when you come to the clinic. Nearer to the time of your appointment, we will need to carry out a brief self-declaration health questionnaire with you over the phone.
At your NUMA appointment:
Should your health change prior to your appointment please do let us know.
We look forward to seeing you
Many thanks
Kind regards
NUMA team
