Request An Appointment

Please complete the form below. Someone from the Southern Nevada Community Health Center will contact you within one business day to set up an appointment.

Name*

First Last

Date of Birth*

Month

Day

Year

Gender*

Male
Female

Contact Phone*

Email*

Enter Email Confirm Email

Are You a New Patient*

Yes
No

Is there a specific service you are seeking?*

Please select any service(s) you or a family member may require.

Which days work best for you?*

Please select all that apply

Insurance Provider

Comments

This field is for validation purposes and should be left unchanged.