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Initial Enrollment Request Form

You have three options for scheduling an enrollment:

  1. Call OHS Enrollment Specialists at 1(855) DUI-8055 to schedule an enrollment into our program.
     
  2. Call the OHS office directly Monday - Friday between the hours of 9:00 AM - 6:00 PM or on Saturday from 9:00 AM to 3:00 PM (Oakland, Mountain View and San Marcos offices ONLY).
     
  3. Fill out the form below and submit via e-mail to OHS and someone will contact you to schedule an appointment.

San Mateo County

Select the program you are required to attend.


Contact Information

*This form will send your message to OHS as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with OHS through email, you accept associated risks. OHS does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your PHI and PII, you may call 1(855) DUI-8055.