Hawai‘i Mental Health Pro Bono COVID-19 Project
While our state faces unprecedented times during the COVID-19 pandemic, the Project realizes that the mental health and well-being of Hawaii’s residents is of utmost importance.

To help individuals seeking psychological support during this time, mental health experts, including psychologists, marriage and family therapists, clinical social workers, and mental health counselors, are offering free telehealth services to those WITHOUT health insurance or proper health insurance benefits. If you have insurance, please contact your insurance company.

Our online services are available on a first-come, first-served basis, and we ask for your patience as mental health services are in high demand. To register, please complete the request form below and you will be notified when a mental health care provider becomes available.

Our services aren’t suitable for extremely urgent circumstances as we will not be able to connect you with an available provider immediately. If you’re experiencing severe distress or an emergency, please dial 911 or visit the nearest emergency room. Examples of severe distress or an emergency include: If you are suicidal, being abused, feel like hurting someone else, need immediate attention, or are experiencing a medical crisis.

If you have lost your insurance coverage due to job loss, you may be eligible for Quest. We strongly encourage you to contact the State’s Med-Quest Division - https://medquest.hawaii.gov/ for more information.

While the Hawai‘i Mental Health Pro Bono COVID-19 Project will use its best efforts to ensure the confidentiality of personal information, it is not subject to HIPAA nor is it responsible for the compliance of any individual clinicians participating in the project with regard to HIPAA and any other relevant federal and state laws relating to personal health information
First Name *
Last Name *
Email Address *
May we contact you via your email address? *
Phone Number *
May we contact you via phone? *
The requested behavioral health services are for: *
Required
What is the name of the primary person to be seen (if other than yourself?)
What is the age of the primary person to be seen? *
What is the gender of the primary person to be seen? *
Does the primary person to be seen have health insurance? *
If yes, to insurance, what is the name of the insurance company (e.g., HMSA, HMAA, ect.)
Which Island is the person on? *
Does the primary person to be seen have access to a private space that will allow for confidential conversation with the behavioral health provider? *
Please provide us with a brief description of the problem or concern: *
Any additional information we should know?
How did you hear about us? *
Thanks again for contacting Pro Bono COVID-19 Project! You will be contacted by a provider when one comes available. If this is an emergency or urgent matter, please dial 911.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy