Refer a Patient

Refer an adult for individual telehealth psychotherapy with Jethro Macaraeg, LCSW.

Anxiety

Depression

Grief

Trauma/PTSD

Burnout

Relationship Concerns

Identity and LGBTQIA+ support

Life transitions

Anxiety Depression Grief Trauma/PTSD Burnout Relationship Concerns Identity and LGBTQIA+ support Life transitions

Submit a Referral

Online:
The form takes approximately
2-3 minutes.

Open Form in a New Window

Prefer fax?
Fax form to 808-470-2421

Download Fax Referral Form

Confirm Referral Criteria

  • Is 18 years of age or older

  • Not a Medicare client (currently not accepting at this time)

  • Located in Hawaiʻi during sessions

  • Appropriate for routine outpatient care

  • Patient is aware of the referral and has agreed to be contacted

  • Does not require emergency evaluation or an immediate higher level of care

Privacy & Security Notice

Information submitted through this form is maintained within Cages to Wings Wellness’s Google Workspace account under a Business Associate Agreement with Google. Please include only information necessary for the referral.

Not for emergencies: Follow your practice’s emergency procedures, call 911 or 988, or direct the patient to the nearest emergency department.

Mahalo for the referral!

Mahalo for the referral!

What Happens
After You Refer

  1. Submit referral
    Complete the secure form or fax the referral form.

  2. Review within 1-2 business days
    Cages to Wings Wellness reviews the referral for fit and availability.

  3. Patient outreach
    The patient is contacted directly to discuss next steps and scheduling.

  4. Referral update
    Your practice receives a brief status update indicating whether the patient scheduled, declined, could not be reached, or was referred elsewhere

Secure Provider Referral Form