CareSource Life Services Nevada Referral Form

If you would like to learn more about CareSource Life Services®, please fill out the form below. Note: You don’t have to enroll.

You can reach us at: Medicaid: 1-833-230-2058 (TTY: 711) Marketplace: 1-833-230-2099 (TTY: 711) Or by email at NVLifeServices@CareSource.com. We are open Monday through Friday, 8 a.m. to 6 p.m. Pacific Time (PT). We look forward to hearing from you!

First Name:

Last Name:

Member ID

Address:

City:

State:

ZIP Code:

County:

Phone:

Email:

Who is completing this form?

CareSource Member Employer Community Organization

Name of Employer

Name of Community Organization

Name of person completing the form

Contact number of person completing the form

I would like to receive email from CareSource.
I would like a CareSource representative to call me.
I would like to receive information about CareSource Life Services through the mail.

I am interested in CareSource Life Services for (please check all that apply):

Education Goal
Employment Goal
Linkage to Community Resources (For example: food assistance resources, transportation resources, housing resources, etc.)

This is NOT an Enrollment Application

NV-MED-M-4036573 DHCP Approved: 8/18/2025