Inquiry Entry

Looking for assistance? A member of our Community Resource Connection Team will connect with you to schedule a time to talk.

Simply fill out the form below and a member of our team will be in touch with you. Please only fill this form out once. Someone will be in touch within one to two business days ( Requests are monitored Tuesday through Friday)

First Name

Last Name

Email Address

Phone

Address

Date of Birth

Language Preference?

None English Spanish

Are you a Shareholder/Member of Vineyard Cincinnati?

None Yes No

What services are you interested in?

Are you involved in a Healing Center program?

Yes No

Have you received services from the Healing Center before?

Yes No

Resources & Referrals

Do you need to speak to someone who will listen to your concerns and help you navigate next steps.

Yes No

Are you looking for a job?

Yes No

Are you looking for help with managing your money?

Yes No

Are you looking for help navigating your way back to self sufficiency?

Yes No

Please, briefly describe your situation and the assistance you are requesting.

How can we pray for you?

Submit

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11345 Century Circle W.
Cincinnati, OH 45246
513.346.4080
info@healingcentercincinnati.org