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  • Online Referral Form

     


    Additional Help

    If you have questions or need additional help, please contact us:

    E-mail: Parent Support

    Phone: (520) 724-9721

    Pima County Health Department offers many FREE health programs and services for anyone living in Pima County.

    Refer your patients, students, clients, family members or yourself by completing and submitting the form below.

    After this form is submitted, we will attempt to contact the person being referred within 24 business hours.

    Fields marked with a red asterisk(*) are required.
    Online Referral Form

    Contact Information

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    Preferred method of contact:   

    Requests / Referrals

    Services


       
       

    Education

    Signature and Disclosure Authorization

    By signing below I acknowledge that the above information may be released, discussed, or disclosed to the Pima County Health Department. My signature below also serves as authorization for the Pima County Health Department to contact me by my preferred method of contact selected above. I understand that I may revoke this authorization at any time by submitting a request in writing to the Pima County Health Department: 3950 S Country Club Rd Tucson, AZ 85714. This authorization will automatically expire one year (12 months) from the date of signature unless otherwise revoked in writing.

    By electronic submission of this request form, I hereby certify that I have read and understood the disclosure above and all of the information I have provided is true and correct.

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    Program Descriptions

    Bike and Pedestrian Safety – Free bike safety classes at various locations/times available to any teens and adults over the age of 16. Parental consent needed if under 18. Free bike lights, helmets, or locks provided while supplies last.

    Chronic Disease Self-Management Program (CDSMP) – Free 6-week workshop series at various locations and times. The program is open to the public and is designed to motivate and empower individuals living with a chronic condition by improving their skills in managing symptoms and making healthy lifestyle choices.

    Diabetes Program – Free community classes at various locations/times for anyone over the age of 18. General information about diabetes/pre-diabetes and how to make healthy choices in food, diet, sleep, exercise , medications, etc. provided.

    Health Start – Free home visits and case management by a health worker who provides education, support, and advocacy services. Open to any at-risk woman who is pregnant or postpartum with children under the age of 2.

    Mental Health First Aid – Free 8-hour course on how to identify, understand, and respond to signs of mental illnesses and substance use disorders.

    Nurse-Family Partnership – Free home visiting program for first time income-eligible moms. Clients are enrolled before their 28th week of pregnancy and visited by a registered nurse until their child’s second birthday.

    Oral Health – Free dental screenings and education for pregnant women; dental screenings and topical fluoride treatments for children ages 0-5 years old; assistance finding a dental home and enrolling in government insurance programs; and presentations and trainings for childcare/medical/dental professionals and agencies.

    Smoking Cessation (ASHLINE) – Free individualized coaching services in both English and Spanish for quitting
    tobacco use. Free or reduced-cost medication is available.

    Strengthening Families – Free 14-week program for families to reinforce skills to improve social skills, family relationships, and school performance. Dinner and incentives are provided at each session.

    Substance Misuse Education – Free custom community presentations on drug overdose awareness and prevention, naloxone education, proper medication disposal/storage, drug types and treatments.

    Suicide Prevention & Awareness – Free custom presentations on suicide prevention and awareness, bullying, and behavioral health promotion.

    WIC (Women Infant and Children) Services – Free nutrition education, breastfeeding support, and referrals to
    community resources for income-eligible pregnant, breastfeeding, and postpartum women with children under the age of 5.

    Worksite Wellness – Free step-by-step technical assistance, personalized resources, and training for businesses to enhance or establish an employee wellness program.

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    Health Department

    3950 S. Country Club Road
    Ste. 100
    Tucson, AZ 85714

    (520) 724-7770

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