Patient Pre-Registration

Save time during your first visit! Complete the following forms by following the instructions below.

Option 1

PRINT FORM AND FAX OR PRINT AND BRING IN WITH YOUR ON YOUR NEXT VISIT

  1. Click the desired form button below.
  2. Click inside the BLUE BOX fields and type your responses.
  3. When finished, click the “PRINTER ICON” in the top left corner (or go to File + Print) and print the form from your computer.
  4. Fax the form to 808-249-1651 or bring with you during your next visit.

Option 2

SAVE FORM TO YOUR HARD DRIVE AND EMAIL

** YOU MUST HAVE ADOBE ACROBAT PROFESSIONAL SOFTWARE INSTALLED ON YOU COMPUTER.**

  1. Click the desired form button below.
  2. Click the “DISK ICON” in the top left corner (or go to File + Save a Copy for Internet Explorer).
  3. Save the blank form to your hard drive.
  4. Close the online form. You will be completing the form that was just saved to your hard drive. Find the saved blank form on your hard drive.
  5. Open the saved blank form in Adobe Acrobat Professional.
  6. Click inside the BLUE Box fields and type your responses.
  7. When finished, click “SAVE” to save your changes.
  8. Open your email client of choice (Example: gmail, Microsoft Outlook, etc.)
  9. Compose a new email addressed to receptionist@cancermd.net. Include the appropriate form name in the subject line (Example: “Medical History Form”).
  10. Attach the completed form.
  11. Click “SEND”.

Patient Information

Medical History

Prostate (SHIM)

Prostate (AUASS & QOL)

Consent Form

Symptom Check List

Release Authorization