We noticed you're using an older browser.

If you have trouble accessing the referral forms please click HERE and for the best experience we suggest using one of the following options:

Dementia-Society-Logo-2020
Dementia-Society-Logo-2020

Take A Break Program: Client Profile

Who Are You?


Background Information

Please take a moment to fill out this form together, so that our volunteers can learn a little bit about you. This way, you’ll be able to spend more time conversing than explaining. The Take a Break session will focus on the person living with dementia. Therefore, we would like the questions in this form to be answered from the person living with dementia’s perspective. Thank you for your help, caregivers!


RECOMMENDED POSTS

Welcome to Your Weekly Round-Up

Brain-Friendly Activities and Information! Join the BrainyActive Challenge - Participez au Défi Remuez vos méninges!Saturday, September 19th, the Dementia Society launched the BrainyActive Challenge/Défi Remuez vos méninges, an exciting new virtual eve ...

MEDIA RELEASE: The BrainyActive Challenge

When - OTTAWA, 14 September 2020 September 19 - Thanksgiving2020   Where - Anywhere   What - Join the Dementia Society’ s NEW Virtual Brain Health Challenge   Why - To raise awareness of brain health and funds to supportthe 24,000 people living with de ...

COMMUNIQUÉ DE PRESSE: Défi Remuez vos méninges!

  Quand - Ottawa, le 14 septembre, 2020 19 septembre – Action de Grâces 2020   Où - Partout   Quoi - Participez au NOUEAU défi virtuel de la Société de démence : Défi Remuez vos méninges!     Pourquoi - Pour augmenter la sensibilisation de la santé cér ...

CONNECT WITH COACH
MAKE A REFERRAL
For Professionals
INVITE A SPEAKER
VOLUNTEER
Submit a Form
heartchevron-downarrow-circle-upmagnifiercrossmenu linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram