Forms

Below are some of our most frequently requested patient forms.

These forms may be turned in at your local health center site, or emailed to medical.records@westhawaiichc.org, or call 808-333-3600 with any questions.

• Adult New Patient Packet
• Pediatric/Keiki New Patient Packet
• Minor Power of Attorney
• Release of Information Request (ROI)
• Sliding Fee Scale Application
• Ground Transportation Request
• Air Transportation Request