Appointment Request Form

Please call our office at (808) 528-1717 to make an appointment or utilize the form below to request an appointment with Dr. McKinlay:


Patient’s Name:
Email Address:
Date of Birth:

Have you been seen in our office before?  Yes  No

What is the primary reason for this visit?
Acne Eczema Psoriasis Skin Tags
Aging Skin Growths Rash Stretch Marks
Allergic Reaction Hair Loss Redness Sun Damage
Birthmark Infection Rosacea Warts
Cellulite Moles/Nevi Scarring Wrinkles
Dark Spots Nail Problems Skin Cancer Other

Our office we will need to contact you to verify insurance information, address/phone number and appointment availability.
What is the best phone number to reach you at?   

Our office is open Monday - Thursday 8:30 AM - 5:30 PM and Friday 8:30 AM – 12:30 PM. We are also open two Saturdays per month 8:00 AM - 2:00 PM. We will do our best to accommodate your desired appointment time. Fridays are often used as administrative days and if the choice is not available below then that means a Friday appointment is not available.

The appointment request for:
This Week    Next Week    Three Weeks

Appointment Time Desired (Please Select 2 or 3 Preferred Times Below):
MON AM TUE AM WED AM THU AM SAT
MON PM TUE PM WED PM THU PM