Refer A Carer of someone who has dementia to a Caraway Course for Carers

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This form is to refer someone or yourself to talk to someone from Caraway about attending a Caraway Course of Carers of someone who has dementia.

We will then contact you by email or telephone to discuss the course and how you can attend it.

Details about the courses can be found on our website

Email *

Name and contact details of Referrer. *

Does the Carer and the person who has dementia know you are referring them? *

Yes

Other:

First name of Carer *

Surname of Carer *

Telephone number of Carer *

Email address of Carer *

Address of Carer *

Name of person who is now living with dementia *

What is your relationship with the person who is now living with dementia? *

When was the person who is now living with dementia diagnosed? *

Please tell us something about your situation. We will ring or email you to discuss your needs. *

How and when in the week or day is the best time to contact you? *

Send me a copy of my responses.

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