Below are links to our Patient Forms and Health Questionnaires that we may ask you to fill out. Please check with our office to see which of these forms you will need to complete.

When you click on a form, it will open a PDF file in a new window for you to print, fill out, and mail the completed forms at least a few days before your appointment. Be assured that Dr. Sholl will personally review every form and questionnaire that you fill out.

IMPORTANT: Use our new mailing address:
Wellspring Functional Medicine
P.O. Box 1565
Scarborough, Maine   04070

If you have any questions, please give us a call at (207) 289-1060.

  1. Medical Symptoms Questionnaire
  2. Female Intake Questionnaire
  3. Male Intake Questionnaire
  4. Toxin Exposure Questionnaire – Adult.pages.pdf
  5. Toxin Exposure Questionnaire – Child.pages.pdf
  6. Environmental Exposure History Form.pdf