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    *Note: if you do not receive a response within 48 business hours, it is likely due to a form error. Please call us at (520) 305-9735.

    If need to speak with someone immediately, please call the National Suicide Prevention Lifeline at (800) 273-8255 OR the Pima County Community Wide Crisis line at (520) 622-6000 OR text HOME to 741741.

    By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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