Patient Information

Office Hours

Tuesday through Friday: 8:00am – 4:45pm. Saturday 8:00am – 12:30pm.
Mondays: Office is open for glasses and contact lenses pick up and to schedule appointments.
Sundays: Closed.

Accepted Insurances

We are currently accepting new patients with the following health plans. For all other insurances, please call us at (808) 674-2273.

• HMSA
• HMAA
• UHA
• HMA
• Humana
• Medicare
• United Health Care
• Tricare (Prime and Standard)
• VSP
• Hawaii Electrician Union
• Aetna
• Blue Cross & Blue Shield

Payment Options

Co-payments and payments for procedures must be rendered at the time of the visit. We accept cash, VISA, MASTERCARD and Discover. We also offer CareCredit®, a flexible payment program which offers up to 12 months interest free financing. Please inquire during your visit for more information.

Patient Forms

To save time on the day of your appointment, please fill out these forms online now and submit them directly to our office. If you have any questions, please fill out as much as you can and our staff will be happy to assist you when you come to the office.

For New Patients (Smartphone recommended to fill out this form)

• New Patient Online Registration Form (Please Complete 1-2 Days Before Your Appointment)

For Established Patients (Smartphone recommended to fill out this form)

• Patient Intake Form (Please Complete 1-2 Days Before Your Appointment)

For Telehealth Appointments

• Telemedicine Consent Form

Testing Consent Forms

• Allergy Skin Test Consent

Procedure Consent Forms

• Bleb Needle Revision Surgery Consent
• Chalazion Excision Consent
• Cosmetic Skin Tag Removal Consent
• Ectropion Repair Consent
• Electrocautery Occulsion Consent
• Entropion Consent
• Epilation with Electrocautery Consent Form
• Excision of Eyelid Cyst Consent
• Medical Botox Consent (blepharospasm)
• Medical Botox Consent (strabismus)
• Medical Botox Consent
• Nasolacrimal Duct Consent
• Temporary Punctum Plugs Consent
• Excision of Conjunctival Cyst Consent
• DURYSTA Procedure Consent

Laser Surgery Consent Forms

• ALT Consent
• Focal Laser Consent
• PI Consent
• PRP Consent
• YAG Consent
• Retinopexy Consent

Medical Records Release Forms

• Medical Record Release Authorization Form
• Request for Medical Records to be Sent to Kapolei Eye Care
• Photo/Media Release Form

Optical Forms

• Glasses Order Policy
• Optical Agreement
• Polycarbonate Lens Policy

Contact Lens Consent Forms

If you plan to update your contact lens prescription or have a first time fitting, please read and sign our consent form below:

• Contact Lens Consent Form
• Corneal Refractive Therapy (CRT) Consent 

Cosmetic Consents

• Botox/Xeomix Consent
• Dermal Filler Consent
• Latisse Consent 

Other Consents

• Workman’s Compensation Information Form
• Home Therapy System (HTS) Consent
• Vision Therapy Consent Form
• Dry Eyes/GI Questionnaire

Cancellations

If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. This courtesy, on your part, will make it possible to give your appointment to another patient. A $50 fee will be charged to no-shows.