Hawaiʻi Island Community Health Center provides you with the opportunity to complete or view our patient forms before your appointment. PDF forms are provided below.
- Patient Registration Packet
- Caregiver Authorization Affidavit
- Authorization for Release of Information
- Informed Consent to Receive Family Planning and Contraceptive Supplies
Hawaiʻi Island Community Health Center is committed to protecting the privacy of our patients and complies with the Health Insurance Portability and Accountability Act (HIPAA). We encourage our patients to read their Patient Rights and Responsibilities to be well-informed and discuss their decisions with our health care team.
Three easy ways to submit your forms:
- Fax: Scan completed forms and fax them to the location where you receive care.
- Hilo Womenʻs Health: 808-933-1356
- Hilo Keiki Health: 808-933-2983
- Hilo Family Dental: 808-333-3617
- Hilo Family Health: 808-961-4795
- Pāhoa Family Health: 808-965-6240
- Pāhoa Womenʻs & Keiki Health: 808-965-6240
- Keaʻau Family Health & Dental: 808-966-4028
- Kaʻū Family Health & Dental: 808-929-9087
- Email: Scan completed forms and email them to firstname.lastname@example.org
- In-Person: Bring your completed forms to any of our health centers and drop them off in person for processing.