Patient Forms

We know your time is important.  We have provided forms that can be downloaded and printed out at your convenience.  


If you are new to Hawaii Pain Specialists, we ask that you download, print, and fill out the NEW PATIENT PACKET before your first visit with us.


We are developing a Patient Portal that allows our patients to fill out forms before they arrive in our clinic electronically.  Ultimately, our goal is to provide our patients with a smooth and pleasant visit, where we can focus on you and not on the paperwork.  

Don't forget to bring your insurance card and a form of government ID with you.

In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit.

We accept most types of health insurance. Please contact us for further details.

New Patient Packet
Forms to fill out before your first visit at Hawaii Pain Specialists.
HPS New Patient Packet.pdf
Adobe Acrobat document [178.6 KB]
Authorization and Disclosure of Protected Health Information form
This form allows Hawaii Pain Specialists to access your medical records from your other health providers such as notes, labs, and diagnostic imaging.
HPS Authorization and Disclosure Protect[...]
Adobe Acrobat document [151.4 KB]
Personal Release of Information form
This form allows Hawaii Pain Specialists to release your medical records to a designated person or place you choose other than yourself.
HPS Personal Release of info.pdf
Adobe Acrobat document [135.9 KB]
Honolulu Spine Center Information
This brochure provides information and directions to the ambulatory surgery center where your procedure may be performed.
Adobe Acrobat document [780.7 KB]
Pre-Procedure Instructions
This document provides instructions on what to do before your procedure.
HPS Preprocedure Instructions.pdf
Adobe Acrobat document [175.5 KB]
Post-Procedure Instructions
This document provides instructions on what to do after your procedure and information about what to expect.
HPS Postprocedure Instructions.pdf
Adobe Acrobat document [151.0 KB]
Procedure Informed Consent
This document requires your signature before a procedure and provides information about the procedure being done, the risks, and the benefits.
HPS Informed Consent Procedure.pdf
Adobe Acrobat document [170.1 KB]
Controlled Substances Agreement
This agreement explains the policies and consequences regarding chronic opioids prescriptions.
HPS Opioid Contract.doc.pdf
Adobe Acrobat document [172.5 KB]




Monday - Friday

8am - 4pm



8am - 12pm

Hawaii Pain Specialists

Physicians Office Building II

The Queen's Medical Center

1329 Lusitana Street

Suite 102

Honolulu, HI 96813


Main: (808) 445-9120

Fax:  (808) 445-9124



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