Financial Assistance Form

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If you need help with household obligations during a medical crisis, please call Medina Cares at 330-461-0718, or send us a message using the form below.   

Do You Qualify to Receive Help From Medina Cares?  

To be considered for assistance, a client must meet some specific criteria:

• The person has experienced a qualifying medical crisis in the past 0-9 months. 
• Applicants must be ages 19-64.
  
• The person has accounts that are otherwise in good standing. 
• The person is employed or has an income.
• The person has not received financial assistance from Medina Cares in the past 12 months.

By providing a full name, return contact number, needs, and description of the medical crisis/condition, each case can be properly reviewed by our Board of Directors to ensure assistance is given to qualifying individuals.