Office Forms

On your initial visit, we ask if you could print and fill out the new patient packet prior to coming in for your appointment. This will help Dr. Bardwell make an accurate diagnosis in order to develop an effective treatment plan.

  • New Patient Packet
  • Patient Re-Exam Form
  • Nutrition and Fitness Questionnaire
  • Exercise Fitness/Personal Training
  • Daily Record of Food Intake
  • Symptom Survey & Toxicity Form
  • Record Release Authorization
  • Personal Injury/Questionnaire
  • Motor Vehicle Collision/Personal Injury Questionnaire



For your convenience, we provide our new patient form and other office forms for download online prior to your visit. We ask if you could fill out the forms and have it ready for your initial appointment. If you have any questions feel free to call us at (207) 846 -1665.

New Patient Packet

For your convenience, we provide our new patient form and other office forms for download online prior to your visit. We ask if you could fill out the forms and have it ready for your initial appointment. If you have any questions feel free to call us at (207) 846 -1665.

New patient form packet

New Patient form packet

Patient Re-Exam Form

For our convenience we ask if you would simply print and fill out this form prior to coming in on your next appointment.

Patient Re-Exam Form

Nutrition & Fitness Questionnaire

Below, we offer a questionnaire packet in regards to your nutrition & fitness goals.

Nutrition & Fitness Questionnaire

For your convenience, we provide our new patient form and other office forms for download online prior to your visit. We ask if you could fill out the forms and have it ready for your initial appointment. If you have any questions feel free to call us at (207) 846 -1665.

Exercise Fitness Evaluation/Personal Training

Download document : PAR-Q

Daily Record of Food Intake

Daily Record of Food Intake

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 to take 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.

Download: Daily Record of Food Intake

Symptom Survey & Toxicity Form

Symptom Survey

The Symptom Survey Form 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 that you can use to evaluate the Symptom survey form:

1. The Tally Sheet
2. General Support
3. The 5 main complaint 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.

Download: Symptom survey form

Toxicity Form

The Toxicity Questionnaire is designed to aid the practitioner in assessing a patient's or client's potential need for a clinical purification program.

Download: Toxicity Questionnaire

Record Release Authorization

Personal Injury Questionnaire

Motor Vehicle Collision/Personal Injury Questionnaire