Pediatric Care became Kailua Pediatrics on May 1st, 2026. Currently accepting new patients.
Forms
You may download the forms and email them to us at info@kailuapediatrics.com or bring them on the day of the appointment.
Expecting Parents (Prenatal Visit Questionnaire)
Complete this questionnaire before your prenatal visit to help us get to know your family and prepare for your appointment.
New Patient Registration
Complete your registration forms before your first visit, including patient information, HIPAA acknowledgment, and required authorizations.
HIPAA Form
Review our privacy practices and acknowledge your rights regarding your child's protected health information.
Release of Medical Information
Authorize the transfer of your child's medical records to or from another healthcare provider.
Credit Card Authorization
Securely authorize a credit card to be kept on file in accordance with our office policies.
Patient Portal Child Proxy Access Request Form
Request access to your child's patient portal to securely manage their healthcare online.
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