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Medication Management Form (English)

or

(Spanish Version)

Please be sure to check out the insurances we are currently accepting.

If you have any questions please give us a call (702) 815-1550.

The following links help with filling out the form using Adobe Reader DC:

Click here for how to install Adobe Reader DC. (Download Adobe on Mobile or PC)

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Please email the form to the location you received services at:

Las Vegas: info@serenitymentalhealth.org
Phone: 702-815-1550
Fax: 775-751-6176

Pahrump: pahrump@serenitymentalhealth.org
Phone: 775-751-5211
Fax: 775-751-6176

Carson: Intakes@serenitymentalhealth.org
Phone: 775-841-6050
Fax: 775-751-6176