Patient Information Center
Please download the necessary patient forms and complete at home prior to your first visit. Bring the printed forms when you come in for your appointment. If you choose to fill out the patient form packet at our office, please arrive 10-15 minutes before your appointment to allow enough time to get them completed.
These forms contain live text fields that can be filled out from your computer using the Adobe Reader. For best results download the form to your computer, then fill out, save the form document then print.
Caution: The form can be completed without downloading, but the document is limited to print only and cannot be saved.
Please contact us if you have any questions or need assistance. We’re glad to help!
Select this link to download latest version of the free Adobe Reader program.
Private Insurance – Complete this group of forms if your treatment is covered under private insurance such as (Premera Blue Cross, Aetna, ODS Alaska, and others).
Medicare Insurance – Complete this group of forms if your treatment is covered under Medicare.
Workman's Comp. or Auto Insurance – Complete this group of forms if your treatment is covered under a Workman's Comp or an Auto Insurance carrier claim.
Minor Patient - Complete this form if patient is a minor covered under Medicaid or Private Insurance. Includes: Authorization to treat a minor & Pediatric Questionnaire
Authorization for Disclosure of Protected Health Information – Complete this form if you would like to release your health information.
Patient Registration Kihei Clinic Only – Complete this form if you are a Kihei clinic patient.