Pathways HUB

Free help for pregnant women and new moms.

lccaa.net/pathways-hub
Pregnancy and New Parent Support
- Are you or someone you know pregnant?
- Do you know about community resources available for you and your baby during pregnancy and your baby’s first year?
Referral Type:
Eligibility Criteria (Check all that apply):
Referral Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
Please enter a valid email address. example@example.com
The following information helps to ensure that we are serving communities most impacted by health disparities and may be used for eligibility for certain grants or services. Please indicate your race/ethnicity (check all that apply):

Other
Does the client speak English?
If no, what is primary language of the referral?
Pregnant? Please answer the following questions:
Are you pregnant?
If so, what is your/the client's due date?
Is this your/the client's first pregnancy?
Where do you plan to deliver?
Hospital System
Who is your care provider?
Doula services are recommended and provided free for all enrolled pregnant clients. Do you wish to be enrolled in our Doula Support program?
Are you currently working with a Community Health Worker or other agency?
If yes, please list name(s):
Additional Support Including Diaper Program
Pathways HUB staff can assist you with applications or referrals for the following needs:
If requesting diapers from the Pathways HUB (LCPHUB), please enter the child's age and the diaper size you are requesting.
Emergency diapers can be requested once every 30 days. LCPHUB enrolled clients receive first priority. Eligibility requirements include: Lorain County resident, child under 4, income/benefits verified. Details will be explained when HUB contacts you.
Do you have Health Insurance?
Type of Health Insurance
Medicaid Plan
12-Digit Medicaid Number
Do you have any chronic conditions?
If you are referring someone other than yourself, please provide your contact information.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Information provided by:

Other
Please share anything else we should know.
Submit this form using the button below or email mcarroll@lccaa.net or drop it off at LCCAA, 936 Broadway Ave. in downtown Lorain. Call 440-457-0375 if you have questions.
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Free help for pregnant women and new moms.

Referral Information

Pregnant? Please answer the following questions:

Additional Support Including Diaper Program

If you are referring someone other than yourself, please provide your contact information.