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  • Online Referral Form


    Additional Help

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

    E-mail: MyHealth

    Phone: (520) 724-9721

    The Pima County Health Department is committed to the overall health of individuals, families, and communities by reducing barriers to health resources and basic needs. The Health Department offers most services at no cost.

    Please complete this form, and our team of Health Navigators will contact you within 14 business days.

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

    Contact Information

    *  * 
    Race and Ethnicity:   
    Best time to contact:   
    Preferred method of contact:   
    May we leave a message?      Yes      No
    Does the message have to be confidential?      Yes      No

    Requests / Referrals

    Please select all resources needed

     (see below for description)

           Are there children under 2 years old?
              Yes      No
           How far along in pregnancy?
           Due date:



    Signature and Disclosure Authorization

    By submitting this form, you agree to be contacted by the Pima County Health Department for services requested. In addition to providing its own services, the Pima County Health Department partners with, and remains impartial to, external collaborators.

    My signature below 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.


    Referred from Page: 

    Resource Descriptions

    Bike and pedestrian safety: offers information and education on bicycle safety, including bicycle diversion classes and safe routes to school information.

    Breast/chest and cervical cancer screening: the Well Woman Health Check Program helps low-income, uninsured, and underinsured women access to breast and cervical cancer screening. Services include clinical breast exams, mammograms, pap tests, pelvic exams, ultrasounds, and biopsies, and more.

    Child car seat program: Get enrolled in a car seat safety class and receive a free car seat most appropriate for your child upon completion.

    COVID-19 testing/vaccination: programs provide COVID-19 vaccinations, testing/test-kit distribution, and educational outreach through mobile clinics all across Pima County.

    Disability resources: provides support to individuals with special needs in locating resources and services.

    Employment/job-seeking resources: connects community members seeking employment with assistance from external resources.

    Family planning: provides confidential family planning, counseling, approved contraceptive and other related preventive health services. Minors do not need parental consent.

    Family Skills Training: found to improve parenting skills, family relationships, social competencies, and school performance behaviors, delinquency, and substance misuse in children.

    Food resources: refers community members experiencing food insecurity to available resources and services.

    Health insurance: provides assistance with AHCCCS application and options.

    Housing resources: provides resources for rental assistance, utility assistance and for people experiencing financial difficulties.

    Immunizations: free vaccine services for children and uninsured adults.

    Long-Term Disease Self-Management Workshop: a free, six-week workshop series. Open to the public and aimed at anyone living with a chronic health or pain condition, such as diabetes, or a caretaker for someone with a chronic condition.

    Mental health resources: conducts community trainings and presentations on critical mental health issues such as suicide prevention and mental health first aid and connects vulnerable populations with appropriate resources.

    Oral health: free dental health program for children/ families that provides preventive care, screenings, education, and assistance in finding dental care.

    Overdose Prevention Services: provides prevention education workshops, how-to trainings for the use of naloxone and fentanyl test kits, and connects individuals at high-risk of an overdose with appropriate resources.

    Parental support classes/services: provides parenting support services through evidence-based and evidence-informed programs. Services are available in-home or in a classroom-like setting.

    Pregnancy/postpartum support: provides education, support, and community referrals through two home visiting programs, Health Start and Nurse-Family Partnership, to help families have a healthy pregnancy and raise a healthy baby.

    Sexual health: provides linkage to HIV/STD testing, PrEP (Pre- Exposure Prophylaxis), PEP (Post-Exposure Prophylaxis), harm reduction and exchange services for injection drug users. It also provides targeted outreach testing for HIV/STDs and referrals for HIV positive individuals.

    Smoking cessation (ASHLine): offers free tobacco cessation services to individuals and provides training to worksites or agencies to refer clients to ASHLine directly.

    Stress management: a one-hour presentation on ways to reduce stress and help avoid crises. Various positive coping strategies are discussed.

    Teen pregnancy prevention: provides confidential education and services related to STDs/STIs, contraceptive use, and pregnancy testing and teaches responsible decision making and skill building.

    Transgender health resources: PCHD collaborates with external partners to link transgender and gender expansive community members to gender-affirming clinical care and resources.

    Tuberculosis testing and care: identifies and provides treatment to individuals with active TB disease and latent TB infection.

    WIC (Women, Infants, and Children): a free supplemental food, nutrition education, and breastfeeding education and support program. Services include personalized nutrition tips and support for parents and caregivers, breast pump loan, referrals to other community resources, and healthy foods.

    Worksite wellness: provides Arizona employers with trainings, tools, technical assistance, and resources to design and implement worksite wellness initiatives.

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    Health Department

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

    (520) 724-7770

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