Brit Reis: New Patient

Patient Forms

Is Your Child Sick?^TM

Medical Advice and Tips

Emergencies

Medical Emergency:
Poison Control:
Office After Hours:

Call 911
(800) 222-1222
(808) 524-2575

New Patients

Welcome to our practice! Prior to your first visit, you may refer to the new patient page for more detailed instructions. Please complete our online patient registration . In addition, please complete the following forms and obtain a copy of your child's immunization records if possible. You may fax (808) 261- 6749 or email ilima@reispediatrics.com the completed forms.

Financial agreement form

HIPAA acknowledgement form

Medical decision authorization form

Medical records transfer from another practice form

Patient and family medical history

Patient registration form (if not completed online)

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Patient Forms

Is Your Child Sick?TM

Medical Advice and Tips

Emergencies

New Patients

Is Your Child Sick?^TM