Comprehensive Hypermobility & EDS Intake
Please complete this before your visit. The more detail you share, the better we can prepare for your care.
"If you've spent years being told your symptoms are 'nothing,' I want you to know: we believe you, and we'll take the time to understand what's really going on. Thank you for trusting us with your care."
— Jacques Courseault, MD · Founder & Medical Director
Before you begin
This questionnaire helps Dr. Courseault and the FIT care team understand your history with hypermobility, Ehlers-Danlos Syndrome, dysautonomia, mast cell issues, and related conditions. You only have to tell your story once here — our team reads every answer before your visit. Please answer as completely as you can; it's completely fine to write "unknown" or "unsure."
Fields marked * are required. Sections such as insurance, insured person, and gynecologic/hormonal are optional if they don't apply to you. Your progress saves automatically in this browser, and your completed form is emailed to our care team when you submit.
Thank you — we've got your intake
Your email app should have opened with your responses addressed to The Fascia Institute. Please press Send in your email app to submit your intake.
A member of Dr. Courseault's care team will personally review everything you shared and reach out — usually within 2 business days. You don't need to call us.
Your intake is in.
Our care team reads everything you shared — within 2 business days.
We email you to confirm next steps and scheduling.
In-person consortium-criteria grading and a hypermobility & EDS-focused exam.
"Open email to send" launches your device's default mail app with a short summary for the clinic. If nothing opens, your device may not have a default mail app set — in that case use Copy for Claude or Download note (.md) to save the complete record and send it to fit@fasciainstitute.org. The downloaded note is the full consultation-note package.
Final step: reserve your evaluation
To hold your appointment, a $500 deposit is required. It is non-refundable and is credited toward your $2,499 evaluation — the remaining $1,999 is due at your first visit.
Book & pay $500 deposit →You'll be taken to our secure payment page. After your deposit, our team will confirm your appointment time by email. A Good Faith Estimate is provided before your visit.