Patient Forms

Access our patient forms that you can fill out before your next visit to Jeffrey M. Sakai, O.D. in Honolulu.

Our Forms

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Online Patient Registration Form

If you are a new patient, please use this secured website to register. If you are a returning patient, please call our office to request a password to update your previous information.

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Printable Patient Registration Form [PDF]

If you are a new or returning patient, you may instead choose to download the following registration form and fill it out by hand. For returning patients, if the “General Information” or “Insurance Information” is the same as previous, please make a note of that at the top of the section.

Please complete it and email it to info@sakaioptometry.com or fax it to 808-848-0528 prior to your appointment.

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Printable Notice of Privacy Practices Form [PDF]

For new patients, please read this Notice of Privacy Practices Form and sign at the bottom. Please email or fax it to us prior to your appointment.

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