Client Forms

Here are the forms you need to receive mental health care from Samaritan Counseling Center Hawaii.

Note: To view these documents, you must have Adobe Acrobat Reader installed on your computer.

New Clients:
We ask that you arrive 10-15 minutes before your first appointment to fill out our client forms. You may also download, print, and fill out the forms before your first visit. Please remember to bring your insurance card and a government-issued photo ID.

Returning Clients:
If your insurance plan has changed since your last visit, please fill out and sign a new Insurance Information form.

Speaker Requests:

Our counselors can lead discussion groups and workshops about a variety of mental health issues, including domestic violence awareness, grief counseling, and suicide prevention. If you need a presenter or moderator for your organization or event, please fill out the Speaker Request Form and we will respond as soon as possible.