By submitting this inquiry form, you acknowledge and agree that: (i) The information you provide will be shared only with the SHARENM Navigator, not with any external service provider; (ii) the SHARENM Navigator will contact you by phone or email to assist with your request and help connect you to appropriate services, programs, or resources; and (iii) Submitting this form does not guarantee that you are eligible for services or that a connection to a provider will be made.

Please do not include sensitive personal information. SHARENM is not a HIPAA-covered entity and cannot receive or store Protected Health Information (PHI). For more information about how your data is handled, please read our Privacy Policy