Adult Medical History
This is an electronic version of our adult medical history form. This should be completed and submitted prior to your first appointment at Pohala. This form will take approximately 20-30 minutes to complete. Note: This must be completed no earlier than 14 calendar days prior to your appointment, and no later than the morning of. The answers you provide here are private, and will be used only in regards to your healthcare. These answers are protected under HIPAA.
Email address *
What is the date of your appointment? *
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