Office Forms

Office Forms

For your convenience, we provide our new patient packet and other office forms for download prior to your visit. We kindly request that you fill out the applicable forms and have them ready for your appointment. If you have any questions feel free to call us at (207) 781-5665.

New Patient Packet

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

Patient Re-Exam Form

Please print and fill out this re-exam form prior to coming in for your next appointment.

Patient Re-Exam Form

Nutrition & Fitness Questionnaire

Exercise Fitness Evaluation/Personal Training

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 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

Symptom Survey

Symptom Survey

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.

Symptom Survey

Toxicity Questionnaire

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

Toxicity Questionnaire

Record Release Authorization

Personal Injury Questionnaire

Motor Vehicle Collision/Personal Injury Questionnaire

Informed Patient Consent

Infrared Sauna Release