18 Years and Older
At Reis Pediatrics, even when you turn 18 years or older we encourage you to stay with us if you choose. Because you are now a consenting adult, we need you to complete and sign forms for our practice. We will help walk you through this process.
Step 1 : Complete the Patient Registration Form . Often patients put parents as the guarantor to pay the bills. Check with your parents that this is okay. Some parents get upset that they are paying the bills and do not have access to your medical records. If you need help with explaining this or understanding this yourself, please call our office at 808-263-8822 for our help.
Step 2 : Complete the Authorization to Release Healthcare Information . Since you are now an adult, we can no longer share information with your parents unless you give us permission. You may consent to your parents (or another person) having access to all of your records or only to parts of it. If you would like your parents or another person to be able to have access to your medical records, pick up school forms or prescriptions, or just ask us questions about your health, you have to give us permission. You can limit their access and change this authorization at any time.
Step 3 : After reviewing our Notice of Privacy Practices , sign the Patient-Provider Agreement Form for 18 years and older . This allows us to care for you and submit bills to your insurance company.
Step 4 : Set up your patient portal. You may securely request appointments, refills, and referrals, review your medical records and immunizations and ask medical questions through our patient portal called Passport. If you are not already set up on this, please contact our office at 808-263-8822 or email [email protected] for assistance.
Finally, if you feel you have out grown our practice, we are so grateful for the time you have shared with us. We hope we have helped you grow into a healthy, thriving young adult. To help with the transition of your care, your new physician will be requesting records from us. Once we have received that request we will transfer your records to your new adult physician. Some people choose to pick up a copy of their records or at least a copy of their immunizations. If you would like a copy of your records please complete the Medical Records Request form and call our office for assistance at 808-263-8822 . There may be a fee for this service. After completing the form you may fax it to 808-261-6749 or email it to [email protected] .
Download and Print Forms:
Established patients (18 years and older):
- Authorization to Release Healthcare Information [PDF] [Online Form]
- Registration Form for 18 years and older [PDF] [Online Form]
Patient-Provider Agreement Form for 18 years and older
(Before signing the Patient-Provider agreement form please review our Patient- Provider Agreement for 18 years and older and Notice of Privacy Practices .)