Medical Office referrals

Emergency Assistance If this is an emergency, call 911!

Hawaii CARES provides a team of professionals 24/7 to help in a mental health crisis. ALL ISLANDS: 1-800-753-6879

*We do not provide court-related services or emotional support animal requests at this time.

Requesting Provider/Practice Name

Contact Phone number

Contact Email address

Type of service We are very full for Therapy services at this time, we accommodate requests as we have openings.

Therapy

Evaluation/Assessment (Testing)

*Currently most therapy and testing initial appointments are via telehealth. Play Therapy sessions for children and psychological/neuropsychological test sessions are in person.

We have limited spots for ASD testing for minors starting at the age of 2. For these requests only, which school does the person attend?

Please describe behavioral concerns and/or reason for request if not on accompanying uploaded file.

Name of person for appointment

Age

Contact info (please add contact parent/guardian name if for minor)

For minors, legal custody situation? For Sole or Joint custody, consent from all responsible parties is needed prior to start of services.

Lives with parent(s), no custody arrangements Sole custody Joint custody

Medical referral sheet

Add file

Please upload a file

Mahalo for your contact!

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