Wahiawā Health Phone Number: (808) 622-1618

Waialua Health Clinic: (808) 377-4200
Patient Portal
Wahiawā Health Phone Number: (808) 622-1618

Waialua Health Clinic: (808) 377-4200
CONTACT US LANGUAGES NEWS & EVENTS
Patient Portal

Wahiawa Health – Serving All of Central Oahu

Patient Forms

Patient Feedback Form

Please fill out the Patient Feedback Form (PDF, opens in new tab), print and mail to:
Wahiawā Health, Attn: Compliance Dept., 302 California Ave, Wahiawā, HI 96786

Patient Feedback Form

Notice of Privacy Practice

Notice of Privacy Practice (NOPP)

Release of Information

Records Release

Patient Registration Forms

Adult Registration Packet
Adult Health History
Minor Registration Packet
Minor Health History
No Show Policy
Informed Consent for Tele and Virtual Communications

Behavioral Health Forms

BH Conditions for Outpatient Treatment
BH Treatment Consent
BH Attendance Contract
BH Records Release

Student School Physical Forms

DOE Form 14
DOE Concussion and Sports Physical form for Athletes (Grades 9-12)

School Based Health Center Forms

School Based Health Center Registration and Consent Form
DOE Form 14 Physical Form
Mililani High School Physical Form
DOE Concussion and Sports Physical form for Athletes (Grades 9-12)

Vaccination Forms

Flu Vaccines Consent and Registration

Financial Assistance Form

Sliding Fee Scale Application

Mobile Dental Clinic Registration

Dental SBHC Registration and Consent