LTC Ombudsman Program Inquiry/Complaint Form

We welcome your questions or comments. Please use the form below to contact us. If you would like a reply, enter your name, address (postal or e-mail), and/or phone number. Do not submit personal information such as Social Security numbers or detailed medical history; if we need additional information, we will be in touch with you. 


The LTC Ombudsman Program may also be contacted by calling (702) 486-6930 in Clark County or (888) 729-0571 (toll free) in all other areas.


Please fill out the information below as it relates to your question or concern.


Your Name: 




Telephone Number: 


 Type of Contact:


Name of Resident, if Different: 


Your Relationship to the Resident:


Name of Facility: 


Location of Facility:   


Question or Concern:     


Vulnerable Adult Abuse is NOT to be reported through this form. Click here for more information or contact a Regional Office.