top of page

Become a Patient

Please complete the form below. You will be contacted within 3 business days to complete a brief phone intake.

If you are actively having suicidal ideation, thoughts of self-harm,

or thoughts to hurt others, please stop now and call 911 or your local crisis team.    

Which of the following are you?: (Select one only)

Patient Name

(Legal first and last name, as it appears on your Insurance):

Parent/Guardian Name

(Legal first and last name if appointment is for a minor 17 and under):

May we call and leave a voicemal and/or email at the above listed phone number and email?
Did someone refer you to our practice? If so, who?
Do you have a provider preference regarding who you see at West Oahu Mental Health? If so, who?

Accepted Insurance Plans

​

Please select one or more of the following: Required

©2025 by West Oahu Mental Health

bottom of page