For those unable to complete our online form please download the PDF below of our new patient packet. You can complete the questionnaire and consent and scan and email or fax it back to us via our secure email at: email@example.com or via our secure fax at: (808) 379-3736 The Privacy Practices Notice is for you to keep!
Please note** If previously scheduled, failure to complete this packet at least 24 hours prior to your appointment may result in a cancellation of that appointment.
If you have received services from any other provider within the last 2 years please complete the form below and send or fax it to your previous provider so that we may have a record of your treatment on file.
NOT READY TO COMPLETE THE FORM YET?
If you would like to begin by taking one of our brief quizzes, please choose the one below that more closely relates to your current concerns. We will assess your current needs, match you with one of our incredible counselors and contact you within 48 hours to schedule your 1st appointment.
If you do not find a suitable quiz for your current issues please complete the new patient registration above and we will contact you within 48 hours. You may also call our office at 808-468-2439.
We look forward to meeting you soon!
NEED A COPY OF YOUR RECORDS?
If you would like a copy of your records FROM Serenity Counseling Services to send to another care provider, please complete the release of information below and fax it to our office at Fax: (808) 379-3736 so that we may process your request.
NEED A NEW CONSENT?
You can find it HERE!