1600 Kapiolani Blvd. Suite 600 Phone: (808) 979-0700
Honolulu, HI 96814     FAX: (808) 979-0707

Patient Pre-Registration Form

You may click on the online forms below to access the forms. If you have access to a printer at home, you may fill out the forms online and print out a copy of the forms. This will speed up the registration process when you visit our office the first time. The online forms require Adobe Acrobat Reader installed onto your personal computer. You may click on the Adobe Acrobat icon below to download the free copy of the software onto your computer.

Please complete the Patient Information Form and either the Private Insuranace Form, the Auto Form, the Worker's Compensation Form, or the Liability Form depending on the type of insurance which you will be using to cover your physical therapy. If you have any questions, please contact our office.

Note: Please bring your referral/prescription from your physician, a photo ID and your current insurance cards along with your completed forms.