AssistHers Clients

AssistHers Clients

AssistHers clients are LGBTQ+ women and non-binary individuals with a chronic illness or disability who would benefit from the support of a care team! AssistHers clients must be

LGBTQ+ individuals, who live in an area where volunteers are available and whose needs are not limited to medical care or financial assistance.

AssistHers clients may also be eligible for supplemental food assistance and transportation assistance to-and-from medical appointments. If you think that you would benefit from an AssistHers care team, please fill out the form below.

AssistHers Contact Us - Client

Name*
First Last
Phone*
Email*
Zip Code

Intake File Upload

Once you have completed your AssistHers Intake form, please upload them below. Make sure your form is saved with this filename format: “FirstNameLastInitial_FileName”
Ex. JaneD_AssistHers Intake Form