“Early Childhood Pre-K Health Record Supplement” - Basic ‘Pre-K Form’ accepted by all public Pre-K schools in the state of Hawaii.
Print out the Early Childhood Pre-K Health Record Supplement (Link Below). Only the first two pages are needed.
Note that this is a SUPPLEMENTAL FORM and usually needs to be provided WITH the Student Health Record Form 14, so please complete this form as well.
Fill out the identifying data at the top of the form.
Ideally we will provide this form free of charge at the time of your child’s visit if you request it. If this opportunity has been missed, please confirm that there was a physical within the last year (365 days). If you are not sure of this, please check MyChart or call the office to confirm this before dropping off the form.
We will do our best to fill out the form at the time of drop off but may take up to 3 business days.
Alternatively, if you prefer to have our team print and fill out both the “Early Childhood Pre-K Health Record Supplement” and the “Student Health Record Form 14,” forms and fax/email them to the school, there will be a $10 fee for this service. Please click the link below and allow us up to 3 business days to complete this service.
