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Dementia Friendly Sign-up
* Indicates required question
Name
*
Your answer
Business Name
*
Your answer
Contact details
*
Your answer
Have you attended a dementia friends session?
*
Yes
No
Have your staff members attended a dementia friends session?
*
All my staff have attended a dementia friends session
Some of my staff have attended a dementia friends session
None of my staff have attended a dementia friends session
I have no staff
Have you or your staff completed dementia ambassador training?
*
Yes
No
Please tell us more about the dementia friendly actions you have taken in your business
We wear dementia friends badges / lanyards
We share information about dementia in the workplace and / or with our customers
We display dementia friendly signage such as, money images, yellow signage to show the way in, the way, or the way to the toliets
We are aware of the Herbert protocol
Other:
Would you like more information or resources to help your workplace / business become more dementia friendly?
Yes
No
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Would you like to share anything else with us about your commitment to being a dementia friendly workplace / business?
Please tell us below:
Your answer
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