Virtual Respite Request Form
Thank you for your interest in the Dementia Society's Virtual Respite Program. If you would like to be matched with a volunteer for Virtual Respite Visits, please fill out the below form.
A staff member from the Dementia Society will contact you within 1-2 business days to discuss your request in more detail and provide you with more information.
I am looking for support (check all that apply):
I am looking for support primarily in (check all that apply):
I am primarily interested in:
Light telephone chatting/social visits
Pre-planned virtual activities (music, games, puzzles, photo slideshows, etc.)
I am a current client of the Dementia Society:
I don't know
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service