For more information about Nevada Health Centers, please call us at 800.787.2568.
Nevada Health Centers
Carson City Administration
3325 Research Way
Carson City, NV 89706
Nevada Health Centers
Las Vegas Administration
1799 Mount Mariah
Las Vegas, NV 89106
Patient forms
General Forms
- Notice of Privacy Practices (English PDF)
- Notice of Privacy Practices (Spanish PDF)
- Health History Form (English PDF)
- Health History Form (Spanish PDF)
- Authorization to Share Information Form (English/Spanish PDF)
- Background of Sliding Fee Scale Discount Program (English PDF)
- Background of Sliding Fee Scale Discount Program (Spanish PDF)
- Sliding Fee Application (English/Spanish PDF)
- Patient Demographics Form (English PDF)
- Patient Demographics Form (Spanish PDF)
- Financial Agreement (English PDF)
- Financial Agreement (Spanish PDF)
- Patient Acknowledgement & Consent Form (English PDF)
- Patient Acknowledgement & Consent Form (Spanish PDF)
- HIPAA Acknowledgement (English PDF)
- HIPAA Acknowledgement (Spanish PDF)
- No Show Policy (English PDF)
- No Show Policy (Spanish PDF)
- Release of Medical Information (English/Spanish PDF)
- WIC Release of Medical Information (English/Spanish PDF)
- Patient Portal Proxy Access (English PDF)
- Patient Portal Proxy Access (Spanish PDF)
Dental Forms
- Dental Health History for Adult (English PDF)
- Dental Health History for Adult (Spanish PDF)
- Dental Health History for Child (English PDF)
- Dental Health History for Child (Spanish PDF)
Mammovan Forms
- Mammography Patient Questionnaire (English/Spanish PDF)
- Advisory & Consent for Mammography for Patients with Implants (English/Spanish PDF)
Nevada Children’s Health Project Forms
School-Based Health Center Forms