alarm-ringing ambulance angle2 archive arrow-down arrow-left arrow-right arrow-up at-sign baby baby2 bag binoculars book-open book2 bookmark2 bubble calendar-check calendar-empty camera2 cart chart-growth check chevron-down chevron-left chevron-right chevron-up circle-minus circle city clapboard-play clipboard-empty clipboard-text clock clock2 cloud-download cloud-windy cloud clubs cog cross crown cube youtube diamond4 diamonds drop-crossed drop2 earth ellipsis envelope-open envelope exclamation eye-dropper eye facebook file-empty fire flag2 flare foursquare gift glasses google graph hammer-wrench heart-pulse heart home instagram joystick lamp layers lifebuoy link linkedin list lock magic-wand map-marker map medal-empty menu microscope minus moon mustache-glasses paper-plane paperclip papers pen pencil pie-chart pinterest plus-circle plus power printer pushpin question rain reading receipt recycle reminder sad shield-check smartphone smile soccer spades speed-medium spotlights star-empty star-half star store sun-glasses sun tag telephone thumbs-down thumbs-up tree tumblr twitter user users wheelchair write yelp youtube

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

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.

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 or fax it to 808-848-0528 prior to your appointment.

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.