At ADSS we don't just support people with dementia, we also support the professionals who care for them.

Join a team that cares for you!

Refer someone for support

Fill out the form below to refer someone to Alzheimer’s & Dementia Support Services.

Need help? Call us or Email us.

Your details

Full name

Role/relationship

Phone number

Email address

Are you living with dementia or a carer?

Full Name

Date of birth (dd/mm/yyyy)

Do they have a confirmed diagnosis of Alzheimer's & Dementia?

Address line 1

Address line 2

Town or city

Postcode

GP Surgery Name

Support needs

Consent and Privacy

Please make sure you have permission to share this person’s details. We’ll keep all information safe and only use it to offer support.

I have permission to share this information and agree to your privacy statement.