If you are or think you are experiencing a MEDICAL EMERGENCY, CALL 911 or proceed to the nearest Emergency Room.

For Non-Emergency care After Hours or if Acute/Urgent same-day appointments are not available, we work with Urgent Care Facilities near you to get you the care you need. Contact us to schedule your follow-up appointment, and let us know where you were seen so we can obtain your records.

We look forward to hearing from you!

To request an appointment, or ask a question, please send us a non-urgent message using the form on this page, or call us during normal business hours.
To request medication refills, please click on the refills tab above to be directed to the refill request page
To contact your PCP for urgent matters after normal business hours, please call the Doctors’ Answering Service at (808) 988-2188.

Cachola Medical Clinic, LLC
936 Kalihi Street * Honolulu, HI 96819

info@cacholamedical.com
Phone: (808) 845-9955 | Fax: (855) 975-2944

Appt Requests

Patient Name

First Name

Last Name

Patient Date of Birth

YYYY

What is the reason for this appointment?

(Please be as specific as possible)

Patient Address

Is this a new address?

Phone

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###

####

Is this a new phone number?

Line

Primary Insurance Carrier (e.g. UHA, PSWA, HMSA etc)

Primary Subscriber Name

Primary Subscriber Date Of Birth

Insurance Card Information

(e.g. Subscriber ID#, Group name/number, Plan/Medical number or ID)

Line

Secondary Insurance Carrier (if applicable)

Subscriber Name

Subscriber Date of Birth

Secondary Insurance Card Information, if applicable

(e.g. Subscriber ID#, Group name/number, Plan/Medical number or ID)

If you are or think you are experiencing a MEDICAL EMERGENCY, CALL 911 or proceed to the nearest Emergency Room.

We look forward to hearing from you!

Cachola Medical Clinic, LLC “Caring is our Culture”