Welcome to Online Client Intake.

Please complete Online Client Intake. 

This will help to streamline the process and provide you resources in a timely manner. 

We provide resources and referrals of help to Medina County Residents only.

We may provide assistance to those that live outside of Medina County 
if they are in good standing with one of our a partner churches.

Completing this online form will help us respond to you faster. 
Thank you in advance for your thorough completion. 
We verify all information provided. 

 If you would like resources to other agencies, we are able to provide them. 
Please fill out the form with these guidelines in mind.

Please click Online Client Short Form to continue.
This is a must read!

If you are currently dual eligible, with both Medicare and Medicaid there may be more benefits available to you! 
Starting at NEARLY 0 dollars cost. 

Click the button below to receive more information and signup information! 

Client  Intake