New Patient Form
Interested in The Queen's Medical Center's expansion plans?
Dental Clinic
The Queen’s Medical Center
Lobby Level via Iolani Elevator
1301 Punchbowl Street
Honolulu, Hawaii 96813
Phone:
808-691-4292
Fax:
808-691-5028
Hours:
Monday – Thursday, 8am – 4pm;
Friday, 9am- 4pm;
Closed for lunch 12 pm – 12:45 pm
Thank you for choosing The Queen’s Dental Clinic for your care. Please note that dental residents are selected for a 12-month General Practice Residency Program starting every July and ending in June. This means that the dentist you are assigned to will change every year.
Be sure to bring the following to your appointment:
To expedite your check-in to the Dental Clinic, you may download and complete the following forms prior to your arrival:
New Patient Form
Patient Medication Reconciliation
For new patients, a medical record and a business account will be started by our registrar before services are given.
Submit your completed New Patient Form and form for Patient Medication Reconciliation.
Notify the registrar of any new information, such as new phone number, updated insurance, name change, etc.
The Queen’s Dental Clinic accepts most major dental insurance plans including HMSA PPO, HDS and Medicaid as well as other commercial insurance plans.
If you do not have insurance, our Patient Service Representatives will be able to discuss payment plan options or help you apply for some form of insurance, such as QUEST.
Payments are accepted in cash, U.S. check, or by credit card. Charges for all laboratory, diagnostic, and pharmacy services are separate from your Queen’s Dental Clinic charges. Payment is due at the time of service. Financial arrangements and discounts may be available. Please contact us for more information.
The Queen’s Health Systems
1301 Punchbowl Street
Honolulu, Hawaii 96813
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