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Help Request Form

The information you share below will help us learn more about what you need. This way, our team can find the best ways to help you and make sure we understand what's most important to you.


At Hawaiʻi Care Choices, we do our best to keep your personal information private and safe, just like the law says we should. But please know that this form isn't protected like a doctor's form. It's just here to help us see if our care might be a good fit for you or someone you care about.

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