• Address: Bale Yoga Residence No. B16 Jalan Kertha Lestari, Ds. Sidakarya, Kec. Denpasar Selatan Kota Denpasar, Bali – Indonesia 80224

Indonesia: +62 812-4616-5490  Europe: +62 812-3902-9568  Australia: +61 466-839-944  New Zealand: +61 428 335 555



Admissions Form

I hereby authorize NewHope Rehab Bali and its staff to review and use the information provided in this admissions form for the purpose of assessment, treatment planning, and healthcare services. I understand that my personal information will be kept confidential in accordance with applicable laws and regulations.

Request Submission Form

Please Select
Do you require Detox?
Any history of self -harm/suicide/arson?
Are you currently on probation
Do you have any outstanding warrants?