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: 

 

E-mail: 

 

Telephone Number: 

 

 Type of Contact:

 

Name of Resident, if Different: 

 

Your Relationship to the Resident:

 

Name of Facility: 

 

Location of Facility:   

 

Question or Concern:     

 

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