Forms

Please visit the Appointments and Patient Portal link to the right (or bottom of the page) to register and access many forms online.

Medicare Patients

Mindful Wellness Maui does not participate in the Medicare program at this time.  Therefore, if you choose to work with us, you will need to pay the out-of-pocket rates listed on the Fees page.  To be seen for an initial consultation, Medicare requires that you review and sign the form below. We have pre-populated as much as we can for you.

Medicare Advanced Beneficiary Notice Form (click here)