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Washoe County Senior Services

1155 E 9th St. Reno, NV 89512

(775) 328-2575 or Fax (775) 325-8025

Senior Services Referral Form

Services Being Requested

Is Client Aware and Receptive to Referral/Services?

Referral Name

Current Date

Date Picker


Date of Birth

SSN Known?


Lives Alone

Spouse Full Name

Spouse Date of Birth

When complete please press "NEXT" -->


When complete please press "NEXT" -->

Support Details Known?

Support Name

Referred By

Referral Name

*Washoe County Notice of Privacy Practice is available for review on the Washoe County Seniors Services Webpage under the Form section or click the below link.

Washoe County Senior Services Forms

When complete please press "SUBMIT" -->