Contact
Talk to a person.
Whatever stage you are at — researching for yourself, calling about someone you love, or checking whether we take your insurance — start here.
If you need help now
Crisis support, any island, any hour.
Hawaii Virtual Care is an outpatient program. We are not an emergency service and cannot respond to crises in real time.
If you need help now
Crisis support, any island, any hour.
Hawaii Virtual Care is an outpatient program. We are not an emergency service and cannot respond to crises in real time.
Request a call
Please do not include clinical details here. We will take history securely once we reach you.
In crisis right now? Call or text 988 instead of waiting on this form.
INTAKE FORM — NOT BUILT. These fields collect PHI. The live site leaves this form without a backend on purpose. Do not wire it to Elementor Forms’ default database storage; it needs a BAA-covered endpoint chosen by the owner. Submit label: Request a call.
| Field | Name | Type | Required | Options |
|---|---|---|---|---|
| Your name (required) | name | text | required | |
| Phone (required) | phone | tel | required | |
| optional | ||||
| Which island are you on? | island | select | optional | Select one · Oahu · Maui · Hawaii Island · Kauai · Molokai · Lanai · Outside Hawaii |
| Anything you want us to know before we call | note | textarea | optional |
Ready when you are.
One call, one form — either one ends with a person who knows what to do next.