Pacific Islander Mental Health Network

PACIFIC ISLANDER MENTAL HEALTH NETWORK REFERRAL FORM

If you are in need of mental health services, our organization can connect you to local Pasifika mental health providers and mental health services. You can also ask us about available interpretation services provided by our partners. Please complete our Mental Health Needs Survey and a member of our team will reach out and connect you with providers and other services you may need. Any and all information collected in this survey and intake will be held confidential. Complete the form below or click on the button to access the form on another screen.

Click button to access the referral form in a separate window.

Mental Health Needs Form

Our website is designed to offer general information that informs users about the services that are available through UPIHC and our local mental health providers. The website is not intended to provide medical or therapeutic advice, nor should the information be used to attempt to determine the presence, absence, or severity of any illness or condition which may be perceived or experienced by the user of this site. CALL 911 immediately if you have an emergency medical or safety needs.