Patient Forms & Info

ā€œIā€™m happy to wait with you by the edge of the Sea until The Tide comes in.ā€
— James Jealous, D.O.

To book an appointment:

call (808) 721-5410

*current patients may book online at:

https://www.schedulicity.com/scheduling/TOYS5CM

Evening appointments available upon request

NEW PATIENT INTAKE FORMS

Please fill out and email back to secure email: info@tideosteopathy.com

New Patient Intake Form

HIPAA statement

Insurance Notice/Consent

Pediatric Intake Form


Payments

Now accepting:

*HMSA PPO

*Tricare Select

*Medicare

Fee-for-service

Payment by check and all major Credit Cards

*Services may only be covered under specific plans, please contact our office to find out details about your insurance plan

Payment is due 24 hours before your appointment.

Payments and appointments cannot be made in office. We will contact you 24 hours before your appointment to make a payment online through our secure scheduling and payment service.



Osteopathic treatment (30min) $150

Pediatric treatment (12 & under) $100

New Patient Discount (60min) $200

We understand things can change last minute, if you need to change your appointment, we respectfully request at least 24 hours notice.

For any cancellation or reschedule made less than 24 hours, refunds are not available.