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Disability Rights Ohio Online Intake Form 

Please complete the form below and click “Submit” when you are finished. A DRO staff member will contact you as soon as possible.

Disability Rights Ohio is required to collect demographic information for federal grant reporting purposes. DRO must obtain data to ensure services are available across the state to diverse populations. If you do not want to share this information, you can decline to answer those questions.  No matter how you answer, this will not impact your eligibility for services.

Due to limited resources, DRO cannot fulfill every request for assistance. Still, DRO tries to provide everyone with information and referrals, even when we cannot provide direct representation. 

Please do NOT include sensitive information on this form such as Social Security Numbers or Medicaid/Medicare numbers.

* indicates required information

Person with the disability requiring assistance:

If disability is mental illness, please state diagnosis

Are there any upcoming deadlines, hearings, or meetings related to this issue?

Please note that you will remain responsible for meeting any upcoming deadlines or attending any hearings.

Is there currently an IEP?

Name of the person filling out this request, if different from person with disability:

By submitting this form, you agree and understand that that submitting an intake request does not create an attorney client relationship and does not guarantee legal representation from Disability Rights Ohio.

For internal use only

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