Kohala Coast & MOLOKA`I Urgent Care Clinical Forms

Patient Registration form Revised 0803.docx (pdf)

KCUC Intake Authorization MedRecords Release (pdf)

INFORMED CONSENT FOR OPIOID PRESCRIPTIONS (pdf)

TB-Document-F_State-of-Hawaii-TB-Clearance-Form-20170718 (pdf)

adult photo release (1) (pdf)

minors photo release (pdf)

KCUC VAX FLU VACCINE CONSENT FORM.docx (pdf)

KCUC VAX VACCINE REG FORM.docx (pdf)

KCUC VAX Parental Authorization for Vaccination.docx (pdf)

KCUC VAX COVID Booster Attestation (pdf)

KCUC COVID PCR REGISTRATION FORM - REVISED AUG 2022.docx (pdf)