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.
Which state do you live in?
Are you a full-time or part-time caregiver for a family member?
Not a caregiver
What type of condition does your relative have?
How long since they were diagnosed?
Would you be interested in participating in a free, online support group?
Best phone number to reach you?
How did you hear about us?
How can we help you?
Connecting with people similar to myself
Sharing caregiving tips with others
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This form was created inside of June Care.