At Rocky Mountain Hyperbaric Association for Brain Injuries, we feel that it is of critical importance that honesty and integrity be adhered to in all aspects of our business. We firmly believe in personal accountability for all our actions and expect honesty and integrity from all our clients. We require that you read and sign our Statement of Understanding in order to be considered for a grant from the Rocky Mountain Hyperbaric Association for Brain Injuries.

By signing below, I swear, to the best of my knowledge, that the information I have provided is the truth. I understand that if I am selected to receive financial assistance from the Rocky Mountain Hyperbaric Association for Brain Injuries, and it is found that I have not fully disclosed all required information or I have lied about any information, it will be my responsibility to fully refund the money which I have been wrongly awarded due to my fraudulent actions. Failure to pay back any monies owed could result in legal action. I also understand that I must complete this application in its entirety. Failure to provide all required information and items associated with this application will result in immediate rejection of my application. I further understand that it is not the responsibility of the Rocky Mountain Hyperbaric Association for Brain Injuries to request any missing items from my application. I understand that information of all clients is confidential and I will not divulge any personal information about other clients of the Rocky Mountain Hyperbaric Association for Brain Injuries or any personal information regarding any patients of the Rocky Mountain Hyperbaric Institute.

Along with financial assistance programs to help pay for hyperbaric oxygen therapy treatments, the Rocky Mountain Hyperbaric Association for Brain Injuries does outreach, fundraising, and marketing (i.e. website, seminars, brochures, etc.) work to keep the association information available to the community. Documentation of participant involvement and usage of material (photo, bio, testimonial, etc.) is important in order to share results and the need for the association. Personal health information from the medical director of Rocky Mountain Hyperbaric Institute and your medical care physician(s) will benefit our work and increase our community support. Your release to obtain and share personal and health documentation is needed for this purpose.

As a participant in the Rocky Mountain Hyperbaric Association for Brain Injuries, I authorize permission for the Rocky Mountain Hyperbaric Association for Brain Injuries to collect information from the medical director of Rocky Mountain Hyperbaric Institute and/or my medical care physician(s) regarding my health status and/or improvements since receiving hyperbaric oxygen therapy treatments and usage of my photo, bio, testimonial toward actions mentioned above.