Wahiawā Health Phone Number: (808) 622-1618

Patient Portal

Wahiawā Health Phone Number: (808) 622-1618

Patient Portal

Forms

New Patient Forms

Adult Patient Registration Form
Minor Registration Packet 2023

Authorization and Conditions for Outpatient Services

Authorization and Conditions for Outpatient Services
Request for Records Release

Student and 7th Grade Physicals

Wahiawā Health DOE Registration Packet
Request for Records Release
Hawaii Dept. of Education Concussion and Sport Physical Form

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

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