Referral Form Family

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Making a referral is easy, fill out the form below and let us take care of the rest. You will receive a call from our staff who will create an individualized care plan including education, support and social recreation programs.

Senior couple filling out a form with an advisor.

Individuals, family and friends can fill out our online referral form below to get connected to the Alzheimer Society of Niagara Region.

Individuals, Family & Friends Referral Form

Referral Form Agency

Healthcare providers looking to refer their clients to the Alzheimer Society can complete our online referral form below. Our First Link team will connect your clients to appropriate services including education and counselling.

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Senior couple filling out a form with an advisor.