Please print and complete the new patient packet prior to your initial visit. This will help Dr. Bardwell make an accurate diagnosis in order to develop an effective treatment plan.
New Patient Packet
Please print and fill out this re-exam form prior to coming in for your next appointment.
Patient Re-Exam Form
As a nation, we eat poor-quality foods that have been stripped of nutrients. We do not consume enough fresh fruits and vegetables. Many of us get our whole grains from instant rice, refined wheat breads, pastas, and cereal. We eat a tremendous amount of prepackaged, pre-made meals. One-quarter of Americans eat at fast food restaurants each day. Americans are overfed and undernourished.
We offer a 7 day food diary that we recommend you fill out sincerely in order to make the accurate evaluations of personal goals. Whether it's excessive calories, high glucose consumption, or not enough protein in your diet, we will be able to look back on this diary and offer advice and recommendations in order to strive for wellness.
Daily Record of Food Intake
The Symptom Survey has 224 commonly found symptoms arranged in 9 groups. For example, Group 5 is composed of symptoms related to problems in the gall bladder and liver. Group 6 deals with digestion. There are 4 methods used to evaluate symptoms:
1. The Tally Sheet
2. General Support
3. The 5 Main Complaints method
4. Expanded General Support method with synergists
Make sure to use numbers only (1,2,3) and leave blank if symptoms do not apply.
The Toxicity Questionnaire is designed to aid the practitioner in assessing a patient's or client's potential need for a clinical purification program.