Caregiver Interest Form
June Care is actively accepting participants. Today, we're focused on care-partners of persons living with Alzheimer's or other types of dementia. If you're interested in participating in our virtual, caregiver support program please fill out the information below.
Email address *
First Name
Your answer
Which state do you live in?
Your answer
Are you a full-time or part-time caregiver for a family member?
What type of condition does your relative have?
Your answer
How long since they were diagnosed?
Your answer
Would you be interested in participating in a free, online support group?
Best phone number to reach you?
Your answer
How did you hear about us?
Your answer
How can we help you?
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