RNI & General Clinical Services — Service Request / Referral Form:

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Search Providers
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- Overdose Reversal Medication Finder
- Fentanyl Testing Strip Finder
Contact

RNI & General Clinical Services - Service Request / Referral Form:

CBHC and the Resilient Nevada Initiative offer behavioral health counseling and integrated nursing care across our partner communities. Complete this form and a team member will follow up to connect you with the right service.

Who is this request for?(Required)

Myself

Someone else (a family member, client, or patient)

Your name (or the name of the person you're requesting on behalf of)(Required)

First Last

Best way to reach you(Required)

Phone

Email

Either is fine

Phone number(Required)

Email address(Required)

What type of support are you looking for? (check all that apply(Required)

Behavioral health counseling

Nursing / integrated care support

Case management or referral to other resources

Not sure — help me figure it out

Are you currently connected to one of our partner sites (for example, Quest Counseling, Boys and Girls Club, or another community partner)?(Required)

Yes

No, I'm not currently connected to a partner site

Not sure

If yes, please tell us which one(Required)

Do you have any of the following? (optional — helps us prioritize scheduling

I have limited English proficiency or need language access support

I am uninsured or underinsured

Neither of these applies / prefer not to say

Preferred language for services(Required)

How did you hear about us?(Required)

Referred by a partner organization or provider

Referred by a family member or friend

Found this online

Other (please specify)

Specify(Required)

Anything else you'd like us to know?

Consent checkbox:(Required)

I consent to being contacted by CBHC / Resilient Nevada Initiative staff using the information provided above.

The Community Behavioral Health Collaborative, a part of the School of Public Health at the University of Nevada, Reno.

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About
Staff
Partners
Activities
The Resilient Nevada Initiative
News
Internships & Supervision
Connect with Us
Instagram

The Community Behavioral Health Collaborative is located at the University of Nevada, Reno and administered by CASAT, a Center within the School of Public Health. The CBHC is funded in whole or in part by private donations and foundation support from the Community Foundation of Northern Nevada, Nell J. Redfield Foundation, Dorothy Lemelson Foundation, and Renown Health.

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