If you are experiencing a medical emergency, please call 9-1-1.
If you or a loved one is experiencing a crisis situation involving suicide, please call the National Suicide Prevention Lifeline
at 1-800-273-8255 (TALK).
To contact the Indian Health Service Community Health Representative program, please fill out the form below completely.
To protect you, your family's, or your patient's privacy, please DO NOT include any Personally Identifiable Information (PII) or Protected Health Information (PHI) on this form.
Examples of PII and PHI are: personal phone number(s), personal address, individual health condition(s), Social Security number (SSN), date of birth (DOB), patient name (if not your own), and patient registration number.