Reclaim Normal Lives

De Novo is one of the leading addiction rehabilitation clinics in Salt Lake City, UT. Complete the rehab intake form below if you’d like to get started. You may also call us during business hours to speak with one of our staff members to set up an intake.

pre-intake form

Name *
Call Back Number
Call Back Number
May we call you back at this number? *
Would you prefer we call you back from a blocked number?
Are you over 18?
If you are under 18 are you over 16 and will your parent/guardian be willing to sign for permission to treat you?
Seeking treatment for:
(Please check all that apply)
If you are seeking treatment for opioid use do you have an idea as to whether you would prefer?

Book An Appointment

At De Novo we do intakes every morning from from 5:30 AM to 6:30 AM. Please plan on at least two hours to complete the intake process. Upon receiving this rehab intake form we will call you back to set up an appointment. We also welcome walk-ins at our addiction clinic, but these will be handled in the order they arrive after scheduled appointments. Call us to learn more about our experienced addiction counselors.