New Patient Forms – Maui

All the necessary patient information forms are available here as PDF files. Click on the links to download the files you need. You may submit the documents to us at our Maui office:

  • Email us
  • Fax: 808-871-1441
  • You may also bring the completed forms with you on the day of your appointment

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New Patient Registration Form

Contact Lens Fitting Examination

Medical Release Forms

Financing Options

  • CareCredit – Up to 24 months promotional period
  • Lending USA – 6 month promotional period and then goes into a fixed rate
  • Alpheon Credit – Up to 24 month promotional period
    • Apply for Alpheon by Texting: Text BEST to 97788. This will send an application link right to your smart phone