All of our intake forms are provided through our Patient Portal, which you can access at: https://foundationalconcepts.janeapp.com/login.
For your convenience, we’ve also included printable versions of the forms below. These can be used for initial review or as a backup if needed, though we do prefer that all forms be submitted online.
First-Time Patient Forms
Please complete the following two forms before your first appointment. These are required and serve as your consent for treatment, acknowledgment of our cancellation policy, authorization for the release of medical records, and agreement to financial and insurance responsibilities.
Informed Consent Form
Medical History Questionnaire
Outcome Measure Forms
Please complete the following at your therapist’s request.
