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Covid-19 Information and Policies

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  • Home
    • News & Events
    • Covid-19 Information & Policies
    • Employment
  • About
    • History
    • What We Do
    • Mission Vision & Values
    • CEO Message
    • Board of Directors
    • Leadership Team
    • Community Partners
  • For Patients
    • Patient Forms
  • Services
    • Healthcare Professionals
    • Medical Services
    • Health Insurance
    • Women’s Health
    • Behavioral Health Services
    • Dental Services
    • Patient Education-Care Coordination
    • Patient Assistance Program
    • Substance Use Disorder Outpatient Treatment Program
    • Tobacco & Vape Treatment Program
    • Health & Wellbeing
  • Clinic Locations
    • Honoka’a Clinic
    • Kohala Clinic
    • Laupāhoehoe Clinic
    • Waimea Clinic
  • Ways To Give
    • Donors
  • Contact Us
    • Privacy Policy

Patient Forms

Download and print patient forms, and bring them to your health clinic. 

General Registration

Authorization And Release Form & Patient Consent Form

Patient Provider Contract

Notice Of Privacy Practices And Acknowledgement

Authorization for Release Of Medical Records

Authorization to Accompany And Provide Consent for a Minor 

Sliding Fee Scale Application 2024

For further assistance, call us at (808) 775-7204.

Let's Get Started To A Healthier You

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Hamakua Kohala Health logo
  • Home
    • News & Events
    • Covid-19 Information & Policies
    • Employment
  • About
    • History
    • What We Do
    • Mission Vision & Values
    • CEO Message
    • Board of Directors
    • Leadership Team
    • Community Partners
  • For Patients
    • Patient Forms
  • Services
    • Healthcare Professionals
    • Medical Services
    • Health Insurance
    • Women’s Health
    • Behavioral Health Services
    • Dental Services
    • Patient Education-Care Coordination
    • Patient Assistance Program
    • Substance Use Disorder Outpatient Treatment Program
    • Tobacco & Vape Treatment Program
    • Health & Wellbeing
  • Clinic Locations
    • Honoka’a Clinic
    • Kohala Clinic
    • Laupāhoehoe Clinic
    • Waimea Clinic
  • Ways To Give
    • Donors
  • Contact Us
    • Privacy Policy
  • Home
    • News & Events
    • Covid-19 Information & Policies
    • Employment
  • About
    • History
    • What We Do
    • Mission Vision & Values
    • CEO Message
    • Board of Directors
    • Leadership Team
    • Community Partners
  • For Patients
    • Patient Forms
  • Services
    • Healthcare Professionals
    • Medical Services
    • Health Insurance
    • Women’s Health
    • Behavioral Health Services
    • Dental Services
    • Patient Education-Care Coordination
    • Patient Assistance Program
    • Substance Use Disorder Outpatient Treatment Program
    • Tobacco & Vape Treatment Program
    • Health & Wellbeing
  • Clinic Locations
    • Honoka’a Clinic
    • Kohala Clinic
    • Laupāhoehoe Clinic
    • Waimea Clinic
  • Ways To Give
    • Donors
  • Contact Us
    • Privacy Policy

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