To be filled out by all new patients and patients who have not been seen at the office for more than three years.
Please print, complete and bring the forms noted below to your next appointment. In addition, remember to bring your Photo ID, your insurance card, and your co-payment (if applicable). Annual forms and insurance cards/picture IDs need to be brought to each annual appointment.
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
We participate with most local and many national insurance plans. However, it is your responsibility to understand whether your insurance has limits on the doctors you can see or the services you can receive.
We will submit claims to your insurance carrier and receive service payments. You may be responsible for co-payments, co-insurance, or other deductible amounts depending on your insurance..
Please call your insurance carrier should you have questions.
We accept HMSA, Blue Cross Blue Shield, UHA, QUEST (HMSA, Alohacare, Ohana, United Healthcare), HMAA, HMA, PWSA, HMA, MEDICARE and all local Hawaii insurances, and national plans including United Healthcare, Cigna, Aetna and Humana. Please check with your insurance if you have an HMO plan as you may need a REFERRAL from your Primary Care Provider.
TRICARE SELECT is accepted. TRICARE PRIME is accepted only for Gynecology visits. For Obstetrics, a REFERRAL is required.