Forms

New Patient Forms – Adults and Minors

Adult Patient Registration Form

Minor Registration Packet 2023

Authorization and Conditions for Outpatient Services

Request for Records Release

New Patient Forms for Student School Physicals

Wahiawā Health School Registration Form

Request for Records Release

Student and 7th Grade Physicals

Request for Records Release

DOE-Form 14 - 7th Grade Physicals

Sports Physicals – Students

Request for Records Release

Hawaii Dept. of Education Concussion and Sport Physical Form (Grades 9-12)

Flu and COVID-19 Vaccination Forms

Flu Vaccine Consent and Registration Form

COVID-19 Vaccine Registration Form

COVID-19 Pre-vaccination Checklist Form

Financial Assistance Forms

Financial Assistance Application/Sliding Fee Scale Application

Homeless Verification

Behavioral Health Forms

BH Treatment Consent Form

BH Request for Records Release

BH Attendance Contract

BH Conditions for Outpatient Treatment

Notice of Privacy Practice (NOPP)

Notice of Privacy Practice (NOPP) Form

Community Health Needs Assessment

We conduct a Community Health Needs Assessment to involve our community in identifying the collective health needs so that we may build relevant programs to address your wellbeing.

Community Health Needs Assessment PDF