Your Healing Journey Starts Here.

Who is this enquiry for?

🔒 Privacy Notice

Please do not include diagnosis, symptoms, medication history, treatment history, trauma details, substance-use details, insurance information, crisis information, or any other protected health information in this form. Submitting this form does not create a provider-client relationship, guarantee admission, or replace a clinical assessment.

📋 This form is for callback coordination and general program guidance only.

⚠️ Emergency Notice

For emergencies or immediate safety concerns, call 911 or call/text 988.

Tell Us About Yourself

Thank you for your enquiry. A member of our team will contact you if further information is required. No pressure — just a conversation to understand how we can help.

Name

First Last

Phone

Reasons for Inquiry

Best Time to Call

Reaching Out for a Loved One

Seeking support for someone you care about can be an important first step. Please complete the form below with your contact information only. A member of our intake team will contact you to discuss available services, eligibility, and next steps.

Name

First Last

Phone Number

Email address

Your relationship to the Individual

Please provide the individual's contact information only if you have their permission, are legally authorized to act on their behalf, or are requesting general guidance about services. Do not include clinical details in this section.

Your Contact Information

Name

First Last

Phone

Is the Individual 18 Years of Age or Older?

Yes

Unsure

Reasons for Inquiry:

Best time to reach you

How did you hear about us

Get in Touch

📞

Phone

+1 (801) xxx-xxxx — Coming Soon

📧

frontdesk@hoperestorationut.com

📍

Location

9500 S 500 W, STE #103
Sandy, UT 84070

🕐

Office Hours

Mon – Fri: 9:00am – 5:00pm MT
Lunch: 12:00pm – 1:00pm (Closed)
Sat – Sun: Closed

What Happens Next

Request ReceivedYour basic contact request is sent to Hope Restoration Center for follow-up during normal business hours.

Intake Follow-UpOur intake team will contact you during normal business hours to answer general questions, review referral details if applicable, and discuss next steps by phone.

Program GuidanceIf appropriate, we will help determine which of our outpatient behavioral health services may be a good fit and explain the next steps for consultation, scheduling, or referral to the appropriate level of care.

Submitting this form does not create a provider-client relationship, guarantee admission, or replace a clinical assessment.