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Clinic Forms 

.NOTE: If you are a physician and referring a new patient, please complete and fax the referral form, along with any applicable evaluation/procedures, recent office notes, hospital/rehab notes and/or specialty visits related to diagnosis. 

 

Physician Referral Form 

Policies 

Child Intake Form 


Adolescent/Adult 

Intake Form  

 

© 2024 Wala'au Therapy, LLC.

2148 Awapuhi St.

Hilo, HI 96720

Office: (808) 365-8128

Fax: (808) 961-6383

Office hours:

Monday-Friday 8AM-5PM

Sat/Sun- Closed

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