Online Admissions Form |

Welcome! House of Hope staff are here to help!

Please feel free to fill out this form about your interest in seeking treatment and one of our staff members will be in contact with you about next steps.

Contact Information

1. Name *
2. Email *
3. Phone *
4. What is the best way for us to contact you? *

A few questions.......

5. Have you or the person you are trying to help had an assessment? Would you like our help getting an assessment? *
6. Do you currently have Medicaid? *
7. Do you have private insurance? *

Program Information

8. What is the County where you live? *i.e. Utah County, Salt Lake County, Davis County, etc.

Parent Program

9. Children birth-8 years old may enter treatment with you. Are you interested in learning more about our Parent's program? *

Last Thoughts

10. Any further questions or comments?

Thank you! We look forward to talking with you.

Please feel free to contact us at 801-487-3276 Ext. 1201

Don't forget to hit submit before exiting this page!

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