Board of Health

Healthy Lifestyle

Health Commissioner

Health Department

General Information

Comm. Res. Connector Referral

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Stark County THRIVE

Referrer Information

Referred by:
- If 'Self' is checked, skip to Client Information below

Client Information



How do you prefer to be contacted? *

Best time(s) to reach you by phone or text: *
(check all that apply)

By checking this box, you are giving permission for the Community Resource Connector to contact you:

If a minor, Parent/Guardian 'Signature' is required:

In lieu of a signature, the parent/guardian name should be entered in this field.

* Required

Stark County THRIVE will contact you within 48 hours.


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