Request An AppointmentRequest An AppointmentPlease 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 YearGender*MaleFemaleContact Phone*Email* Enter Email Confirm Email Are You a New Patient*YesNoIs there a specific service you are seeking?*Please select any service(s) you or a family member may require. Dental Health Family Health Family Planning Health Education Primary Care Refugee Health Sexual Health Well Child ServicesWhich days work best for you?*Please select all that apply Monday Tuesday Wednesday Thursday FridayInsurance ProviderEmailThis field is for validation purposes and should be left unchanged. Updated on: February 20, 2020 snhd_admin2020-02-20T16:23:55-08:00