New Adult Client Enrollment Application

If this is a crisis, call the DBH 24/7 crisis line at (801) 773-7060

Please complete the following Adult Admission / Enrollment Application.

Provide all applicable information and click the ‘SUBMIT’ button when complete.

Demand for services fluctuates. It is possible that you may be placed on a waiting list.

Once you submit the enrollment form, someone from Davis Behavioral Health will call you to discuss your application and the wait time for your first appointment.

Please complete a separate form for each client.

Step 1 of 5

Davis Behavioral Health provides services for Davis County, Utah residents only.
- Yes, I am a resident of Davis County
Name of Person Making Contact*
Relationship to Client*
Client Name*
First Middle Last
Primary reason for seeking services*