Please call our office at 808-249-8887 to find out which documents you will need to complete, and whether we participate with your medical insurance. Your privacy is very important to us. Any information you provide is confidential. Please read our Privacy Policies handout.
Adobe Reader software is required to view and print these documents. Scroll down to the bottom of this page for more information. You can download and print the forms for completion with a black or blue pen, or use Adobe Reader to fill-in all the highlighted fields and print when completed. Our office’s preferred method of receiving your completed documents is by mail or fax. Our contact information is on the first page of the Patient Registration Forms.
Click onto the document’s name to open:
- Patient Registration Forms
- Patient Registration Forms when referred by Workers’ Compensation Physician
- Buprenorphine Treatment Agreement Forms and Information for outpatient-based addiction treatment
- Authorization for Release of Medical Information Form – patient requesting copies of their own medical records
- HMSA Injury Illness Report Form
Hints & Troubleshooting Suggestions:
- Adobe Reader is required to complete fillable PDF forms. If your computer does not have Adobe Reader installed, please visit Adobe’s website for this free software. Adobe Reader must be installed on your computer before you can use your computer to fill out forms.
- A purple box across the top of the document will include the words “Please fill out the following form…” and on the right side of the screen, you should see the words “Highlight Existing Fields.” The form should display light-blue shaded boxes for you to type into. Boxes outlined in red indicate required information. If this information is not displayed, it is possible you do not have required “Adobe Reader” installed on your computer.
- Internet Explorer and Mozilla Firefox seem to work well for PCs, and Safari usually works well for MACs.
- PC users will not be able to use the Adobe Viewer (Adobe Reader is required). Even when Adobe Reader is installed, some web browsers such as Google Chrome default to the “Chrome PDF Viewer” which will cause problems.
- How to adjust Google Chrome settings (especially if no other web browser is available) by disabling the Chrome PDF Viewer, so Adobe Reader can be used instead:
Launch/Open Google Chrome
Click on Chrome Address Bar
Type in: “about:plugins”, then press the ENTER key
A list of plugins will appear
Click “disable” next to “Chrome PDF Viewer”
- MAC users must be sure that the MAC’s default “Adobe Preview” is disabled since Adobe Reader is required. Adobe Reader for MAC must be installed before you can use your computer to fill out any of the forms.
- This link to Adobe Reader’s Learn & Support page can teach you how to use Adobe Reader to complete forms with your computer.