Accessible Version
Hawaiian Island Dental

New Patient Forms

Save time by filling out necessary forms online. Feel free to give us a call if you have any questions.

Patient Login

Existing patients can login to our portal using the link below!

Book Online

If you are a patient of record and would like to request an appointment, please book online using this form.

COVID-19 Patient Screening Form

Patient Information Form

Health History Form (Pt 1)

Health History Form (Pt 2)

Insurance Information

PHI Release Form

Authorization for the Release of Records

Office Policies

Bone Graft Consent

Crown or Bridge Treatment Consent Form

Extraction Consent Form

Implant Consent Form

Nitrous Oxide Sedation Consent Form

Root Canal Treatment Consent Form

Scaling and Root Planing Treatment Consent Form

Teeth Whitening Treatment Consent Form

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (808) 245-8866
View the ADA Accessibility Statement