Back in Balance Wellness Center offers our patient form(s) online so you can complete it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.  Our fax number is (207) 947-7321. 

New Patient Health History Form - Required

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Nutritional Consultation Patient Forms - Required

There are three forms (System Survey, ALCAT Survey & Diet Log) that will need to be completed (at least 3 days of the diet log) before you can be seen for your nutritional consultation.  If you can, please fax or drop off the two surveys before your appointment date and bring the diet log with you to your consultation.

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!