VMS_Online Support Group Programme

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VMS_Online Support Group Programme_Registration Form

Greetings from Vayomanasa Sanjeevani!

We are an outreach initiative of Geriatric Clinic & Services, NIMHANS (An Institute of National Importance), Bangalore.

We are running an online support group programme for family members of persons living with dementia.

The meetings are held once weekly, on Saturdays (except 2nd Saturday).

Timing: 3 pm - 4 pm.

Who can participate?

Any family member of a person living with dementia.

Do I need to be a patient at NIMHANS to attend these meetings?

Not necessarily. Although treatment and medical supervision by any health professional is strongly advisable.

How much do you charge per meeting?

Zero charges. This is a service oriented initiative.

Name *

Age *

Gender *

Male

Female

Prefer not to say

Other:

Education *

SSLC

PU/ +2 / Diploma

College or its equivalent

Masters or its equivalent

Ph.D or its equivalent

Occupation *

Currently Employed? *

Yes

Prefer not to tell

Language of choice *

English

Kannada

Hindi

Other

How long have you been caring for your loved one living with Dementia? *

Age of your Loved one living with Dementia *

Phone number (WhatsApp)

Note: *Kindly DO NOT add +91 or 0 before your 10 digit mobile number.*

Which City / District are you currently residing at? *

Kindly select topics that seem to be of your interest

a) Understanding Dementia

b) Dealing with Individual Activities of Daily Living

c) Handling Activities of Daily Living

d) Anger, Aggression and Apathy in Persons with Dementia

e) Managing Sleep Disturbance

f) Ensuring Safety of your loved one with Dementia

g) Identifying and addressing psychological symptoms of dementia, and

h) Planning for Long Term Care and Taking Care of Yourself as a Family Member

Remarks: (mention if you prefer any other language / specific concerns you would like our team to address)

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