Nevada POLST forms are available for health care providers or facilities. There is no cost for the forms upon pickup; there is only a cost if a requester needs the forms delivered (a valid 9-digit FedEx account number is required for shipping).
Because the Nevada POLST form is a medical order, Nevada POLST forms are only available to health care professionals and medical facilities. Individuals interested in completing a Nevada POLST should contact their physician.
Forms can be ordered in quantities of 50, 100, 200 or 400. After your order is received, you will receive an email from staff indicating your forms have been shipped or are ready for pickup. If there is a delay in fulfilling your request, staff will notify you via email.
- You must provide a valid 9-digit FedEx account number.
- Your account will be charged according to the weight of the number of forms ordered.
- Forms typically ship out within 2 to 3 business days.
- Occasional delays occur due to high demand and supply of forms. You will receive an email if any delays occur.
There is no cost for Nevada POLST forms when pick-up is selected on the above form. See pickup information below.
- Las Vegas
- 4220 S. Maryland Pkwy., Suite 810, Bldg. D, 89119
- Phone: 702-486-6515
- Dini Townsend Hospital, 480 Galletti Way, Building D, Sparks, 89431
- Open 8:30 am - 4:30 pm M-F
- Look for the gazebo when approaching from the north at Northern Nevada Adult Mental Health Services campus. The building is closed to the public due to the COVD-19. When you arrive call and let them know that you are here to pick up POLST forms.
- Phone: 775-688-0465 or 775-688-2001
- Carson City
- 727 Fairview Drive, Suite E, 89701
- Phone: 775-684-1030
Printing Nevada POLST forms
POLST forms may be printed; however, it is preferred that this form be printed double-sided on hot pink paper to make it more easily identifiable. This is a recommendation to better ensure easy recognition, it is not a requirement.