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ALOHA...WELCOME TO MAUI, HAWAII

To Check Availability: 808-357-3504

Client Medical History Form

Interested in our services? Get in touch with us via the form below and we'll get back to you as soon as possible!

Do you have now or have you ever had any of the diseases and conditions below (if yes please check box)
Do you currently use any Prophylactic antibiotics
Are you currently taking any medications?
Are you taking any vitamins or herbal supplements?
Are you taking any over the counter medications?
Do you currently use IV drugs?
Have you ever had a blood transfusion?
Have you ever been exposed to HIV/AIDS?
Are you allergic to latex?
Do cuts on your skin heal with normal scars?
Do you smoke?
Do you bleed easily?
Do you have artificial joints, pins or screws?
Do you require antibiotics prior to surgery?
Are you pregnant?
Have you had a hysterectomy?
Have you experienced menapause?
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Thank you for contacting us. We will get back to you as soon as possible

Contact Information

ALOHA HAIR REPLACEMENT CENTER

Phone: 808-357-3504

Hours of Operation

Mon-Fri: 8-5pm

Sat: 10-4pm

Sun: Closed

Address

Maui, Hawaii 

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