Vally Medical Group, APC

82 Puuhonu Pl Ste 202-203 Hilo, HI 96720

PHONE: (808) 935-6353

EMAIL: vallymedicalgroup@gmail.com

New Patient Intake

Emergency Contact

Injury Information

Insurance Information

Employment Information

Physical Work Requirements

Work Environment

Zero Tolerance Policy

Notice to all patients:

Please be advised that Vally Medical Group has adopted a zero-tolerance policy.

"Our providers and staff will not tolerate any disrespectful, rude, aggressive or abusive behaviors in any way."

As your provider, our staff is working endlessly to provide the best care possible. I do not like to discharge patients. However, any person behaving in an abusive and disrespectful manner to myself and to my staff will be discharged immediately.

- Zain Vally Mahomed, MD

Cancellation Policy

Due to an increase in "No-shows" and late cancellations we will be charging a $35.00 fee for any person not arriving by your scheduled appointment time. There is no grace period.

Failure to cancel 24 hours prior to a scheduled appointment will result in this fee, which is the responsibility of the patient, not the insurance company.

Patient Acknowledgment & Signature

By typing your name above, you acknowledge that all information provided is true and correct to the best of your knowledge, and that you agree to all policies listed above.