Aging Registration

Aging Adult DC Counter


Geauga County Department on Aging

Annual Registration
2015 
     
The Geauga County Department on Aging welcomes everyone regardless of race, religion, gender, sexual orientation, gender identity,  national origin, physical or mental disability, or any other basis prohibited by law.


Department on Aging 2015 Online Registration





Mailing Information - If different.

In Case of Emergency Information

Residence Information












Nutrition Information

During the past 7 days, how would you rate your ability to perform:
excluding washing back and hair

During the past 7 days, how would you rate your ability to perform:

During the past 7 days, how would you rate your ability to perform: