Open Enrollment Appointment

1 Personal Information

2 Book Appointment Date / Time

Name*
First Last
What is your Language Preference?*
- English
- Español
Date of Birth*
MM
DD
YYYY
Mobile Phone Number*
Please provide a mobile phone number. Make sure you have access to the provided phone number as a confirmation text will be sent to this number.
Are you a Ryan White Provider Scheduling an appointment on behalf of your client?*
- No
- Yes
Please fill out your name and email address.
Ryan White Case Worker's Name*
First Last
Case Worker's Email*
Enter Email Confirm Email

By providing your email address, you will receive email notifications regarding this appointment from Nevada Department of Health and Human Services.
Appointment Confirmation*
Please select the method how you would like to receive confirmation reminder of appointment.
- Select All
- SMS Text Message
- Email
SMS Text Message*
- I agree to receive SMS Text Messages
I authorize Nevada Medication Assistance Program (NMAP) and Access to Healthcare Network (AHN) to contact me by SMS text message for program related information. Message & data rates may apply.
Email*
Enter Email Confirm Email

Please make sure you have access to the provided email address as a confirmation email will be sent to this email address.
Email Agreement*
- I agree to receive Email Messages
By providing your email address, you will receive notifications regarding your appointment from Nevada Department of Human Services.