Patient Forms
| Patient Information |
| Medical History Questionnaire |
| Notice of Privacy Practices |
Please complete the forms listed above and bring them with you to your exam. You may also fax or email these forms to our office ahead of time. If you are a contact lens wearer, please bring in any boxes or old prescriptions so we can verify the type of lens you are wearing during your exam.
Fax: (808) 737-2307
Email: office.drmod@gmail.com
Mahalo,
Dr. Miyasaka & Staff
Fax: (808) 737-2307
Email: office.drmod@gmail.com
Mahalo,
Dr. Miyasaka & Staff