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Request Free Assistance From A Community Health Worker

CareNet’s community health workers (CHWs) provide free assistance and support to low-income residents. CHWs connect clients to needed medical and social services, including housing and transportation. Complete this form to request free assistance from a CareNet CHW.

Name(Required)

Email

Phone(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code

What assistance are you seeking from a community health worker?

Pregnancy

Chronic disease management

Health coverage

Primary care provider

Specialty care provider

Housing

Transportation

Diapers and other baby supplies

Medication

Food

Clothing

Utilities

Substance use

Mental health

Domestic violence

Employment

Financial planning

Smoking cessation

Legal services

Translation services

Other

Consent(Required)

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