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Apply for Services

The Application for Services form is available online or for download in both English and Spanish. A Doctor Referral Form (sometimes called an Eye Medical Report) is also available for download by Doctors referring a client to DBS. 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 (New)

Our new "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 (Microsoft Word Documents)

Application for Services

Release of Information Form

Application Forms - Spanish (Microsoft Word Documents)

Aplicación a la solicitud de los servicios

Autorización para divulgar información médica

Doctor Referral Form or Eye Medical Report (Microsoft Word Document)

Confidential Patient Eye Report