Service Intake

Start Your Request

Select the form that matches your situation. All submissions are reviewed by a licensed care coordinator.

Urgent or time-sensitive? Call: (520) 201-4033 — Do not use this form for medical emergencies. Call 911.

Prefer to call? (520) 201-4033 — direct clinical response, or email info@nursenavigatorspro.com

01 — Families

Care Consultation Request

Schedule a no-obligation discovery call with a Nurse Navigator. Tell us what’s happening — we’ll tell you in 15 minutes what we can do and whether we’re the right fit.

First Name *

Last Name *

Email Address *

Phone / Text *

I am a: *

Primary Area of Need *

Urgency

General Questions or Scheduling Notes

Please do not include diagnoses, medical record numbers or other protected health information.

This form does not create a client relationship. For life-threatening emergencies, call 911. Nurse Navigators is not an emergency response service. See Privacy Policy.

What Happens After You Submit

01A care coordinator reviews your intake and follows up directly.
02You'll receive a call to schedule a 15–30 minute discovery conversation.
03We'll explain what we can do, answer your questions, and assess fit — no obligation.
04If it's a match, we assign your Navigator and build a plan together.

02 — Facilities & Operators

Compliance Audit Inquiry

Request a Navigator Survey Compass mock audit, regulatory gap analysis, policy overhaul, or compliance retainer engagement. A Compliance Coordinator will contact you to coordinate.

Facility Name *

Facility Type *

Bed / Unit Count

Point of Contact *

Title / Role

Direct Phone *

Corporate Email *

Scope of Engagement *

Timeline

Additional Context

Submitting this form does not create a consulting agreement. A coordinator will contact you to discuss scope and terms. See Privacy Policy.

What Happens After You Submit

01A Compliance Coordinator reviews your inquiry and follows up directly.
02We schedule a brief scoping call to understand your facility's needs and timeline.
03We provide a written engagement proposal and scope of work.
04Upon agreement, your engagement begins with a dedicated Nurse Navigators compliance lead.

03 — Professional Partners

Professional Partnership

Hospitals, discharge planners, social workers, physicians, and care professionals — initiate a client referral or explore a formal referral partnership with Nurse Navigators.

Your Information

First Name *

Last Name *

Organization / Facility

Your Role *

Direct Phone *

Professional Email *

Referral Details

Type of Request *

Referral Context *

All referrals are confidential. For urgent clinical referrals, call directly: (520) 201-4033.

Our Referral Promise

01All referrals are reviewed — urgent inquiries prioritized by clinical triage.
02You'll receive confirmation once we've made contact with your client or family.
03We don't compete with your services — we complement them.
04Families pay us directly. No insurance billing complications on your end.

04 — Nurse Navigators Care

In-Home Care Service Request

Request Nurse Navigators Care — in-home personal care, ADL support, companionship, and caregiver services with clinical nurse oversight built in. Contact us for pricing.

Who's Making This Request

Your First Name *

Your Last Name *

Email *

Phone / Text *

Relationship to Person Needing Care *

Primary Care Needs *

Estimated Hours Per Week

General Questions or Care Goals

Please do not include diagnoses, medical record numbers or other protected health information.

Submitting initiates a care inquiry only. A Nurse Navigators Care Coordinator will contact you to assess needs, confirm availability, and discuss rates and scheduling. See Privacy Policy.

Nurse Navigators Care — What to Expect

01A Care Coordinator contacts you directly — urgent inquiries prioritized by clinical triage.
02We conduct a brief needs assessment call (15–20 minutes) to understand care requirements.
03We match an appropriate caregiver or care team and confirm scheduling and rates.
04Care begins with clinical nurse oversight built into every arrangement from day one.

05 — General

General Inquiry

Media, speaking requests, vendor inquiries, or questions that don't fit the categories above — send us a message and we'll route it appropriately.