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Submit Caregiving Resources
Use this form to submit resources to our database.
All resources should be related to caregiving in Nevada. You will be contacted if clarification is needed.

Step 1: New resource or update:
 New           All fields are required.
 Update     * Indicates required field.
Step 2: Information about your resource:
* Name of Agency or Service:

* Person Submitting:


* Contact First Name:

* Contact Last Name:

Add New Contact

  Address Type:

* Address 1:
   (Street address, P.O. Box)

  Address 2:
   (Suite,Unit,Building,Apartment,etc.)

* City:

* State:

* Zip Code:

* Phone 1:

  Fax:

  Phone 2:

* Email:

  Private Email?
   (Select YES to keep your email private)

Add New Location

Website:

Description: Be sure to include any keywords or other names by which the resource is known.

Ages:

Criteria for Services or Eligibility:

Fees:

If Fee structure, enter amount:

Income Criteria:

Hours of Operation:

List Languages:

Step 3: Choose Counties:
Select the counties in which your services are available.
Please select at least one county.
  Carson
  Churchill
  Clark
  Douglas
  Elko
  Esmeralda
  Eureka
  Humboldt
  Lander
  Lincoln
  Lyon
  Mineral
  Nye
  Pershing
  Storey
  Washoe
  White Pine
Step 4: Choose Categories:
Please select your agency's primary service(s). Other services you provide may be mentioned in your narrative but not as a separate category. A primary service would be the main specialty or predominate focus of your business/agency.
Categories: (mouse-over category name for definition)
  Abuse Reporting
       Abused Dependent Adults
       Child Abuse Reporting/Emergency Response
       Domestic Violence Issues
       Elder Abuse Reporting
  Adult Day Program Centers
  Advocacy
       Advocacy for Children/Adolescents
       Advocacy for Families
       Advocacy for Homeless
       Advocacy for Seniors
  Alzheimer's Disease/Dementia
  Assisted Living Facilities
  Case/Care Management
  Community Clinics
  Community Services
  Community Wellness Program/Activities
       Community Wellness Programs/Activities for Children and Adolescents
       Disability/Special Needs Programs/Activities
  Dental Referrals/Services
       Adult Dental Referral/Services
       Pediatric Dental Referral/Services
  Disaster/Emergency Issues
  Education
       Children/Adolescent Education Programs
       Special Needs Education/Programs
  Employment
       Disability Related Center Based Employment
       Senior Employment
       Special Needs Job Development
       Vocational Rehabilitation
  Financial Issues
  General Counseling Services
  Hearing Impairments/Services
  Home Health Agencies
  Home Repair Services
  Home Safety Evaluations/Accommodation/Modifications
  Hospice Care
  Hospitals
  Housing Information and Referral
       Accessible Housing
       Emergency Housing
       Low Income/Subsidized Housing
       Senior Housing
       Supportive Housing
  In Home Care Services/Homemaker/Personal Care
  Information and Referral
  Insurance Issues
  Legal Services
  Medical Care
       Family Medicine
       Geriatric Medicine
       Pediatric Medicine
       Specialty Medicine
  Medical Equipment/Supplies/Assistive Technology
  Mental Health Services
  Nursing Facilities/Nursing Homes
  Nutrition Related Public Assistance Programs/Meal Services
  Prescription/Medication Services
  Rehabilitation Issues/Rehabilitation/Therapy Services
  Respite Care
  Safety Issues/Assistance
  Senior Centers
  Senior Companion Programs
  Substance Abuse Services
  Support Groups
       Adult Support Groups
       Children/Adolescent Support Groups
       Family Support Groups
  Transportation
       Disability Related Transportation
       Paratransit Programs
       Senior Ride Programs
  Veterans Benefits Assistance
  Visual Impairments/Vision Information/Services
Step 5: Agree to Terms and Submit your Resource:
 I agree to update our resource information at least three times a year upon receiving an email reminder or sooner if we have changes that would effect the consumer.


To help us combat spam, you are required to enter the CAPTCHA code displayed above EXACTLY as shown (case sensitive) in order to submit via our web forms. To generate a new code, simply click on the "Regenerate Code" button below. Any required fields that are not filled in correctly will appear at the top of the form in RED. A conformation message will appear if the form has submitted correctly. After your information has been added you will be notified and asked to verify it's accuracy.
Click the button below to submit your resource. After your information has been added you will be notified and asked to verify it's accuracy.



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