New Patients
Hugh N. Hazenfield, M.D., F.A.C.S.
You may complete the Registration and Medical History Forms (including those for professional singers, professional speakers, and actors) prior to your office visit in order to save you time. You may complete the Insurance Information Form on-line by clicking here:
Adobe Acrobat Reader© is required to complete the following forms. You may download the program free from the following link:
http://www.adobe.com/products/acrobat/readstep2.html
Open each form which you need with Adobe Acrobat Reader©, print it in order to complete it by hand, and then
Use your internet browser's "Back" button to return to this page.
DO NOT CLOSE (X) THE WINDOW.
Then do the same for each form that you need.
If you have completed the Register On-Line Form, you need to complete only the History Forms when you come to the office. After completion of the necessary forms, bring them to the office at the time of your visit.
If you do not complete the Register On-Line Form, you may wish to bring, mail, or fax your completed Registration Form to the office. My fax number is (808) 622-0066.
Click to register or complete the applicable form(s):
To return to Doc Hazenfield's Home Page, click here:
