West Hawaii Community Health Center provides you with the opportunity to complete or view our patient forms before your appointment. PDF forms are provided below.
West Hawaii 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.
New Patient Forms – Medical
New Patient Forms – Dental
Eligibility and Assistance Forms
- SFS (Sliding Fee Scale) Policy Feb 2016
- SFS (Sliding Fee Scale) Discount Application
- Application Requesting Financial Hardship
- Income Declaration Form
For questions about Insurance Eligibility, please call (808) 327-0803.