Forms

Forms

As a convenience, we are happy to provide the following forms on our website. Click below to open, print and bring the forms to your first visit with Foundational Concepts!

The Informed Consent form covers our conditions and your consent for treatment, as well as our cancellation policy, your authorization for release of medical records and your financial and insurance responsibilities:

Informed Consent
Medical History Questionnaire

The outcome measures below allow us to track your progress over the course of your therapy.

PFIQ-7
Pelvic Floor Disability Index
Vulvar pain functional questionnaire
Male NIH Chronic prostatitis symptoms
Female NIH Chronic prostatitis symptom index
Female Sexual function Index