888.648.8732
419.337.4579

View Upcoming Events

February 27 & March 13, 2017
February 27 & March 27, 2017
March 6, March 13 & April 10, 2017
February 13 & March 6, 2017

To Make A Referral

If you are referring a child to Northwest Ohio Help Me Grow, please fill out the form below:

Parent/Guardian/Mother's Name
Parent/Guardian/Father's Name
Address
City
Ohio Zip
Phone (home)
Phone (cell)
Child's Name
Sex
Male          Female
DOB/Due Date
County
Reason for referral and other pertinent medical information
Parent's First Child
Yes          No
Eligible for WIC
Yes          No
Eligible for Medicaid
Yes          No
Primary Language
Submit
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1210 North Ottokee Street | Wauseon, OH 43567 | 888.648.8732 | 419.337.4579