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ADAPTIVE OXYGEN TREATMENT SERVICES SCHEDULE

1. Definitions:
 
1.1. When used in this Service Schedule, the following terms have the following meanings: 

 “Adaptive Oxygen Treatment Fee(s)” means the fee paid by the Client for the performance of the Adaptive Oxygen Therapy Services for Eligible Individuals, as set out in this Service Schedule.
“Adaptive Oxygen Treatment Services” means the Cyclic Variations in Adaptive Conditioning (CVACTM) services offered through TELUS Health Care Centres, as further described below.
“Plan” has the meaning set out in subsection 3.1(a) of this Service Schedule.

2. Service Schedule Term and Timeline 

Service Schedule Effective Date: Date of signature as recorded by TELUS Health Care Centres systems
Service Schedule Term: The term of this Service Schedule begins on the Service Schedule Effective Date specified above and ends upon the expiry of the Agreement Term as set out in Section A, Service Details.

3. Special Terms and Conditions:
 
3.1. General Terms for Adaptive Oxygen Treatment Services

1. This Service Schedule and the associated Adaptive Oxygen Treatment Fees expressly exclude all services that are insured under a Provincial Insurance Plan (“Plan”). 
2. Supplier will make available the Adaptive Oxygen Treatment Services, the details of which are set out in section 4 below.
3. Client acknowledges that Supplier delivers the Adaptive Oxygen Treatment Services through a combination of its staff, and its subcontracted network of Health Professionals.  All Health Professionals are responsible for complying with their respective ethical and practice standards, guidelines and obligations in the performance of Adaptive Oxygen Treatment Services.  
    

4. Adaptive Oxygen Treatment - Service Description
 
Eligible individuals will first review and sign a consent form.  They will then be seated inside a Cyclic Variations in Adaptive Conditioning (CVAC™) pod, which uses variations in pressure to simulate variations in altitude. 

5. Adaptive Oxygen Treatment Services Fees and Payment Terms

5.1. Adaptive Oxygen Treatment Services Rates 

5.2.Payment Terms

Payment is due upon completion of onsite services. Payment method on file will be charged.

5.3 Cancellation and No Show Fees 

1. You will be charged a fee for canceled or postponed appointments if sufficient advance notice of the cancellation or postponement is not provided in writing to THCC (“Cancellation Fees”). The Cancellation Fees are set out in the table below and may be subject to change upon advance written notice to you.

SCHEDULE TO THE PURCHASING, SCHEDULING AND SERVICES AGREEMENT 
ADAPTIVE OXYGEN TREATMENT CONSENT FORM

I have expressed interest in the Adaptive Oxygen Treatment Services through TELUS Health Care Centres (“THCC”). This is an uninsured service, but may be reimbursable through employer paid benefits. 

Service Description and Restrictions

The CVAC(TM) pod uses variations in pressure to simulate variations in altitude. Some small percentage of  people may have difficulty in equalizing the pressure in their ears while in the pod. This can be similar to difficulty in equalizing pressure during such activities as air flight, traveling in mountainous areas, swimming or diving into shallow water. Please discuss any difficulties you may have with equalizing pressure in your ears during any type of activity and any history of problems with your ears with the THCC staff prior to your session.

Symptoms related to a cold, flu, sinus allergies or infection, toothache or infection can prevent a person from equalizing the pressure in their ears while using the CVAC System; these could lead to pain. Please do not attempt undergoing Adaptive Oxygen Treatment services until these kinds of symptoms have resolved.

Assumption of Risk

I understand that this service can cause minor injuries such as sore ears (similar to air travel) and moderate to severe injuries such as those associated with barotrauma to the ears, nose, eyes and sinuses. 

By completing this form I confirm that:

I have read (or had read to me) and understand the information provided in this consent and I hereby consent to participating in THCC’s Adaptive Oxygen Treatment Services. 

I confirm that I do not have any contraindications that would render it unsafe for me to receive the above services, such as;

• I do not have a cold, flu, sinus allergies or infection, toothache or infection, or any condition that would prevent me from equalizing the pressure in my ears while using the CVAC System.
• I am not restricted from commercial airline travel.