New Patients – Patient Intake Forms

Instructions for filling out Intake forms if you have an Initial Office Visit scheduled.

If you have an Initial Allergy Assessment appointment, there is a different set of forms that you have to fill out at your appointment.

Please download the age appropriate Intake Forms, Informed Consent and Agreement of Terms onto your computer. Please fill them out on your computer, save under your Name and email them back to me at least 5 days prior to your appointment. Please call the office to get the email.


Adult Intake Form

Pediatric 0-5 Years

Pediatric 6-12 Years

Release of Medical Records


Patient Login

Center for Innovative Medicine Honolulu

Center for Innovative Medicine Honolulu