PLEASE COMPLETE COVID-19 QUESTIONNAIRE BEFORE YOUR NEXT SCHEDULED APPOINTMENT
HAVE YOU RECENTLY BEEN IN CONTACT WITH ANYONE WHO HAS TESTED POSITIVE FOR Covid-19? If YES, please STOP HERE.
I understand that I have the responsibility to immediately notify Hawaii health and my professional service provider should my responses on the questionnaire change.
** If unable to electronically submit , please print, complete and email to [email protected] ot you may call 808-357-3504.