Mahalo for using our online appointment request service. By taking a few minutes to complete this form, you - or your healthcare representative acting on your behalf - can request an appointment with a Kaimuki Care specialist. To expedite your request, please provide as much information below as you can.

We will contact you within 24-hours to confirm your appointment. If you submit your request on a holiday or Friday afternoon through Sunday, we will respond by the end of the next business day. If you do not hear from us within this timeframe, have questions, or prefer to make an appointment by phone, please call Kaimuki Care at (808) 734-0020 and we would be happy to assist you.

* Indicates Required Fields


Patient Information

First Name*

Last Name*

Middle Name/Initial

Date of Birth*

Email

Phone Number*

How did you hear of us

Appointment information

Insurance Company

Insurance Type

Visit Type*

Routine Exam Illness Injury

Reason for Visit*

Preferred Appointment Date*

Perferred Appointment Time*

:

Verification Code*

Verification

Enter the validation code seen above in the field below:

Disclaimer: If you register, make an appointment or submit any other information online, all your information is transmitted securely and is held in strictest confidence, adhering to HIPAA guidelines and protecting your privacy.

The information contained in this site should not be used as a substitute for the advice of an appropriately qualified physician or other healthcare provider. The entirety of information provided on this website is for educational purposes only. It should in no way be considered as offering medical advice. Please see a physician if you suspect you are ill or need important medical advice or information.

 
 
   

© 2010 Kaimuki Care. All rights reserved.