Patient Forms

Please click on the links below to securely complete and submit our online forms prior to your appointment. If you are unable to submit the forms prior to your appointment, please plan to arrive in 10-15 minutes so that you may complete them in our office.

Please keep in mind:

Completing these forms can take 10-15 minutes.
Please complete the forms and click submit to make sure your work is saved.
Be sure to bring your insurance card to your appointment.
Call our office with any questions you may have.

Looking for a pediatric dental practice in the

Waipahu, HI

area

? Call

808-671-0055

to schedule your child's appointment today!

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Contact our office today to schedule your appointment!

Keiki Smiles of Leeward

ADDRESS

94-229 Waipahu Depot Street, #501

Waipahu,

HI

96797

DIRECTIONS

PHONE

808-671-0055

Appointment Request

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By submitting this form, you agree to receive email, text, and phone communications from our office. SMS Messages from the office will include: appointment reminders and follow-ups regarding due dates and scheduled appointments. Our Privacy Policy and Terms & Conditions can be viewed by clicking here. Users will have the option to opt out of receiving texts by replying STOP. Standard data rates may apply.

Please note that e-mail is not a secure form of communication. Medical information placed here may not be confidential. This form should not be used by children under the age of 18. If you prefer to speak to us directly, you are also welcome to call us so that we may assist you.

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