American Board Certified in Pain Medicine
American Board Certified in Anesthesia
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Fax: 877-234-3819 (new)
Email: mpc@mauipainclinic.net
1063 Lower Main St.
Suite C-213
Wailuku, HI 9679Dear Patient,
In order for our pain clinic to best care for your needs, the information on these forms are extremely helpful in our ability to diagnose and treat your condition. The below links can be downloaded and either printed and completed by hand or directly edited as a Word Document and returned to us by fax or email. Please return this form in order for us to contact you for an appointment date. For a map showing our clinic location and credit card payments, please review the map or click on the credit care button below:
Patient 's Pain Questionaire Form below:
Notice of Privacy Practices (Please read, then print and sign last page):
Please review our policies prior to your appointment with Maui Pain Clinic.
Maui Pain Clinic is not accepting Quest, Medicaid, or HMSA for insurance reimbursement. For those patients with HMSA PPO insurance products, reimbursement for care will be between you and your insurance carrier.
* For those who do not have installed Microsoft's Word software on their computer, Microsoft does provide a Word Document Viewer which is free. This viewer can be used to view and print Word documents, but you will not be able to edit these documents. To install this software, please click on the link below and download the viewer as instructed.
Driving Instructions to Maui Pain Clinic: When driving from Kahului on Lower Main St make a left when arriving at the light where Waena St meets Lower Main St or a left just prior to this light (the side of the building we are at). You can park on the first floor and take the stairwell up to the second floor or go up the ramp to the second floor and park in the non reserved parking slots toward the middle of the building. Look for the sign PHYSICAL REHABILITATION (C-213) signs, as we are sharing their clinic as of Sept 1. The building is devided in half. We are in the northeast, Kahului side. Go to the nearest entrance and go to the end of the hallway. Look for C-213 toward the middle of the building.
