Whether you’re a PCP, caregiver, or parent, you can find and complete the form you need to get started below. All forms are HIPAA-compliant to ensure the safety and privacy of patients.

For Primary Care Providers (PCPs):

• PCP registration form (for PCPs new to NV PAL)
• PCP patient submission form (for registered PCPs would like to submit patient info and schedule a callback)

For Families / Patients:

• Consultative Consent Form (English)
• Consentimiento Para Consulta (Spanish)

For Schools:

• School-based consultation request form (prior to submitting consult request, please see our school-based program orientation process and counties where this pilot program is available)