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 and Spanish PDF)
- Background of Sliding Fee Scale Discount Program (English)
- Background of Sliding Fee Scale Discount Program (Spanish)
- Sliding Fee Application (English and Spanish – PDF)
- Patient Information Form (English)
- Patient Information Form (Spanish)
- Patient Acknowledgement & Consent (English)
- Patient Acknowledgement & Consent (Spanish)
- HIPAA Acknowledgement (English)
- HIPAA Acknowledgement (Spanish)
- No Show Policy (English)
- No Show Policy (Spanish)
- Patient Release of Medical Information
- WIC Release of Medical Information
Dental Forms
- Health History for Adult (English)
- Health History for Adult (Spanish)
- Health History for Child (English)
- Health History for Child (Spanish)
Mammovan Forms
Nevada Children’s Health Project Forms
School-Based Forms