Registration

All forms must be printed out and returned to the Maui Oral Health Center at 752 Lower Main Street, Wailuku, HI. The forms are conveniently combined in packets or available individually (according to child or adult patients). All forms are fill-able and printable.

*Please bring health information and all bottles of medication.

MOHC Packets

• MOHC Registration Packet--CHILD
• MOHC Registration Packet--ADULT

Individual Forms

• Patient Registration & Health History
• Patient Registration
• Consent to & Conditions Agreement
• Policy on Missed Appointments
• Child Consent
• Patient Eligibility
• Ethnicity
• Receipt of Notice of Privacy Practices
• Notice of Privacy Practices