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Application Form

Physician Information
Facilitating Patient Care
Practice Information
Other Practice Locations
Additional Information
Other Office Information
# of Staff/Name
Contact Information
Previous Quality Programs/Organizations
Other Information
Please send a copy of your most recent CV to HIPA Administrator Julie Warech at julie@hawaiiipa.com. Please note: your application will not be complete until the CV is received.


Please Note: The Membership Committee meets every odd-numbered month and will review all new applications at that time.

After receiving approval from Membership Committee, HIPA will set up a meeting to go over Membership Compacts & Contracts. There is a 6-month probationary period for all new members. The committee will reconvene to discuss the new member at the 6-month mark. Please call HIPA Administrator Julie Warech at (808) 524-4041 if you have any questions.