Registration form : HBO Centres in Europe


Please fill in all fields in this form and click the SUBMIT button.
A
llow for a few days delay before your site appears on the listing. Your data will be sent to the ECHM Executive Board for simple verification before being placed in this directory. You may be contacted personally by the national representative of ECHM of your country. This will ensure reliability of the listing at all times.

Name and Address of HBO Centre:  
Name
Name (continued)
Postal adress
Adress (continued)
Postal Code
City
Country
Tel. (administrative) 
Fax (administrative)
E-Mail
Tel. (chamber)
Name of Med Director

Hours of normal operation (office hours):


  From hh:mm - hh:mm

24 hour availability: Yes
                           No

Type of hyperbaric chamber:

Monoplace
Multiplace

Critical Care HBO possible: Yes
                                    No

Time needed prior to start HBO: hh:mm

Located in / associated with hospital?  Yes
                                                    No

Name of Hospital:



Link to website homepage:
Title
URL
 
  In order to check whether you are human and not computer program, please answer the following question:
What is 20 - 6 ?
 



Note: If you experience any difficulties in submitting this form, please print it out and send it by FAX to
Dr Jacek KOT, Fax: +48-58-6222789