Greater Ohio Bleeding Disorders Foundation Membership Sign Up

  • Welcome!

    For nearly 70 years, the Greater Ohio Bleeding Disorders Foundation (formerly the Northern and Central Ohio Hemophilia chapters) has served the factor deficient bleeding disorders community in the 52 counties in Northern Ohio. We look forward to connecting with you!

  • Household Information

    Please include everyone who is immediate family living in the same household only. Immediate family is defined as EITHER patient, parents and minor siblings OR patient, partner and minor children. Please do not include cousins, adult siblings, grandparents, etc. Patient must have a Factor Deficient bleeding disorder to qualify for membership.

  • ***!!! Minor Patients !!!***

    If the patient is a minor, please include parent/guardian information with enrollment.
  • I give permission for the chapter to use me/ my family in photos and/ or videos to be used in chapter marketing materials and publications. Please note that last names will not be used.

  • Let's get to know you!

    Please start with yourself as member 1, head of household.

  • Member 1 - LIST GUARDIAN FIRST

  • What is your connection to the Bleeding Disorders Community? Select all that apply.*

  • What is your bleeding disorder?*

  • I give my HTC or treating hospital permission to confirm my/my family members' bleeding disorder diagnosiswith chapter staff and discuss any eligible chapter benefits.
  • Are you registering multiple family members?*

  • If you do not have any additional family members to add, press next, sign, and submit. If you have additional family members living in the same household, please press next and you will be taken to the next member page.

  • Member 2

  • What is your connection to the Bleeding Disorders Community? Select all that apply.*

  • What is your bleeding disorder?*

  • Do you need to register another individual?*

  • Member 3

  • What is your connection to the Bleeding Disorders Community? Select all that apply.*

  • What is your bleeding disorder?*

  • Do you need to register another individual?*

  • Member 4

  • What is your connection to the Bleeding Disorders Community? Select all that apply.*

  • What is your bleeding disorder?*

  • Do you need to register another individual?*

  • Member 5

  • What is your connection to the Bleeding Disorders Community? Select all that apply.

  • What is your bleeding disorder?*

  • Do you need to register another individual?*

  • Member 6

  • What is your connection to the Bleeding Disorders Community? Select all that apply.*

  • What is your bleeding disorder?*

  • Do you need to register another individual?*

  • Member 7

  • What is your connection to the Bleeding Disorders Community? Select all that apply.

  • What is your bleeding disorder?*

  • In order to ensure we are meeting the needs of those in our community, we may require verification of a diagnosed bleeding disorder by contacting your HTC or other medical facility overseeing treatment. 

    This information will be kept confidential and used solely for the purpose of ensuring those attending programs or receiving services from the chapter have a diagnosed bleeding disorder.

    Your signature below signifies consent to the terms outlined above and that the inforamtion you have provided is accurate to the best of your  knowledge.  If you choose not to accept the terms, your participation in programs or receiving chapter services will be not possible.

    We look forward to welcoming you as a member of our chapter!  Please reach out to Executive Director, Tanya Ricchi: tanya@gobdf.org, with any questions.

  • While membership is ALWAYS free, we accept and appreciate ALL donations! If you'd like to make a tax-deductible donation, please fill out the information below.

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