The Lāna'i Community Health Center's mission is to take care of the community of Lānai by directly providing health services (primary care, dental, behavioral health, and selected specialty services) to the community, providing activities and services through partnerships with local organizations as well as the many off-island organizations reaching out to Lānai by serving as coordinator, advocate, resource, initiator, and convener; and working collaboratively to provide space for partners who can provide needed services for Lāna'i.

Patient Forms and Surveys

Below you will find text links to downloadable PDF forms. To access, view, and print these documents, you will need Adobe Acrobat, which is available as a free software program.

Notice of Privacy Practices

Patient Rights

Good Faith Estimate

Good Faith Estimate

Photo Consent

English

Patient Satisfaction Survey

Needs Assessment

Family Planning Needs Assessment

Reports

Please click on the desired form to download. If you encounter any issues or have questions regarding the forms, do not hesitate to contact our office for assistance.