Family Caregiver Info - for the Dementia Solutions Sessions

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Thank you for your interest in attending our Dementia Solutions Online Support Group Sessions. We are here to support you.

We would appreciate it if you can take a few minutes to complete this short questionnaire regarding the family member with symptoms of dementia that you are caring for.

Once the information has been received, we will email you the Zoom link to join our sessions which occurs on the 2nd Thursday of each month. Thank you in advance for your time.

Email *

Your first name: *

Tell us who are you caring for? (i.e. Mom; Dad; Husband; Wife; Aunt; etc.) *

How long have you been supporting this person? *

Do you know what kind of dementia the person is living with? (Not required. It would just helpful for us to know).

What are your biggest challenges right now as a caregiver? *

Your phone number (in case your email is not working)

Do you wish to receive our monthly e-newsletter with information of our upcoming events as well as other information about dementia? (We don't like spam either so we won't do this to you nor shall we share your email information with others. You can unsubscribe at anytime.) *

Yes

Please share anything else you would like us to know.

Send me a copy of my responses.

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