VMS_Online Support Group Programme_Registration Form
Greetings from Vayomanasa Sanjeevani!

We are an outreach initiative of Geriatric Clinic & Services, NIMHANS (An Institute of National Importance), Bangalore. 

We are running an online support group programme for family members of persons living with dementia. 
The meetings are held once weekly, on Saturdays (except 2nd Saturday).
Timing: 3 pm - 4 pm.

Who can participate?
Any family member of a person living with dementia.

Do I need to be a patient at NIMHANS to attend these meetings?
Not necessarily. Although treatment and medical supervision by any health professional is strongly advisable.

How much do you charge per meeting?
Zero charges. This is a service oriented initiative. 
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Name  *
Age  *
Gender *
Education *
Occupation *
Currently Employed? *
Language of choice *
How long have you been caring for your loved one living with Dementia? *
Age of your Loved one living with Dementia *
Phone number (WhatsApp) 

Note: *Kindly DO NOT add +91 or 0 before your 10 digit mobile number.*
Which City / District are you currently residing at? *
Kindly select topics that seem to be of your interest
Remarks: (mention if you prefer any other language / specific concerns you would like our team to address)
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