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PATIENT FORMS

New Patient Forms

PATIENT INFORMATION/HIPAA FORMS*

PATIENT HISTORY FORM*

Please download both of the above forms and email completed forms to kelli-ann@retinahi.com at least 48 hours prior to appointment or please print and bring the completed forms to your appointment.

(*signature may be required in person)

Medical Records Release

RECORDS RELEASE TO RCH

RECORDS RELEASE FROM RCH

Please complete the appropriate form (with signature) and email to kelli-ann@retinahi.com or mail to the following address.

Retina Consultants of Hawaii

Attn: Kelli-Ann Lum

98-1079 Moanalua Road, Suite 470

Aiea, HI 96701