Jane EMR is a confidential online electronic medical record service. To secure a first visit, please fill out the contact form and a receptionist will add your name, email and number to register your personal account.  

You will receive an email that will direct you to the JANE EMR portal where you can complete intake forms, see upcoming appointment times, and access future plans, records and lab results.

Depending on your needs, you may receive one of the following intake forms along with the four consent forms listed below:

 Naturopathic Medicine Intake Forms

Adult Intake Form

Form which includes comprehensive health history and specialized sections for:

  • Women’s Health
  • Men’s Health
  • Perimenopause
  • Andropause
  • Hormone symptoms and history 
  • Weight loss

     

Naturopathic Medicine Fertility Intake Form

For individuals or couples seeking fertility or reproductive health support, including:

  • Menstrual and ovulatory history
  • Pregnancy history
  • Hormonal and reproductive factors
  • Partner health history (where applicable)

 

Nurse Practitioner (NP)-Specific Clinical Questionnaires

(Completed where applicable)

Hormone Therapy & Metabolic Health

  • Initial Questionnaire: Testosterone Therapy for Women

  • Initial Questionnaire: Testosterone Therapy for Men 
  • Initial Questionnaire: Weight Management & Metabolic Health

You may be asked to complete one or more of these questionnaires depending on your clinical goals and eligibility.

Not all patients will be required to complete every form. Your care team will assign the appropriate questionnaires based on your health concerns and treatment plan.

Consent forms

  • Informed Consent for Naturopathic Care and/or Nurse practitioner care
  • PHIPA Privacy & Confidentiality Consent  (Patient consent form for collection, use and disclosure of personal information)
  • Authorization for Release of Medical Records
  • Cancellation Policy, and no direct billing
  •  Laboratory Testing

 Medical Record Submission

  • Please submit any laboratory reports, imaging results, or relevant medical documents through our secure encrypted web form.
  • We are committed to protecting your personal health information. All submissions are transmitted via Hushmail, a secure encrypted platform compliant with Ontario’s Personal Health Information Protection Act (PHIPA) and applicable Canadian privacy standards.

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