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Apply for Services

The Application for Services form is available online or for download in both English and Spanish. If you’re a doctor wanting to refer a patient for services, please have your patient fill out the Release of Information Form so that DBS may receive medical information from you. To download a document, right click the appropriate link and choose "save link as" or "save target as" on the context menu that appears.

Apply Online for Services

Our "Online Application for Services" system makes the application process easier for you and more efficient for our staff. No electronic documents or paper forms to juggle. Just click the "Online Application for Services" link below and fill out the form in your web browser. A DBS counselor will contact you shortly.

Online Application for Services

If you need more information before submitting an application, you can contact the DBS district office nearest you. Just click on the "Inquire About Services" link below and select the county in which you live. Then give them a call. Our counselors will be happy to assist you.

Inquire About Services

Application Forms - English

Application for Services (PDF)

Release of Information Form (PDF)

Formularios de Solicitud - Español

Solicitud de los servicios (PDF)

Autorización para divulgar información médica (PDF)

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