Client Forms

Please print out & complete all forms prior to your initial appointment.

Adolescent Confidentially Agreement

Client Demographics & Medical History

Client Record Release

Client, Physician & Staff Service Agreement

Protected Health Information (PHI) Policy

ANFP medical compliance letter

Email Communications

Please email any NON-MEDICAL, non-emergent comments, questions or concerns to:

General office contact

Please Note:

New 2013 HIPAA compliance regulations now restrict normal email communications with physicians.

Per the new 2013 HIPPA compliance guidelines email communication that involves ANY protected medical information, ie names, diagnosis, medications, etc must be through an encrypted email portal that is not satisfied with either our Gmail or Microsoft office accounts. Emails may still be sent to individual providers but only non-HIPAA regulated emails will be returned. Please accept our apology in advance for any inconvenience that this may cause. Many health insurance companies are offering HIPAA compliance email portals to better communicate with your physician. Please contact your individual health insurance company for available options.


We accept most types of insurance. Please call our office at 808-961-1400 to inquire if we accept your insurance carrier.

Aloha Nui offers a discount of 20% off appointment costs for all uninsured clients!

Please be aware that all medical insurance co-pays are due at appointment check-in. There will be a $5 surcharge for any billing that must be mailed if co-pays are not paid at time of appointment. Mahalo!

Also, please remember to inform our office of any changes in your health insurance status.