Caredove

Service Information

Service:

Contact an Intake Coordinator
Organization: Alzheimer Society of Toronto
Description:

If you are a caregiver or a person living with Alzheimer’s disease and other dementias, book some time with our Intake Coordinators who can provide information and help connect you to supports.

If you are a professional looking to submit a referral on behalf of your client, please click here for a First Link® referral.

If this is an emergency, please call 9-1-1.
If you are in need of immediate support, please call 2-1-1 or visit https://211central.ca/

Eligibility:*

Are these eligibility requirements met?

You are a caregiver or a person living with Alzheimer’s disease or other dementias and you live in an “M” postal code.

Yes

No/Unsure

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Client Information

Client Name:

First name*

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Family/Last Name*

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Personal Pronouns:

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Email Address:*

Email (Confirmation and reminder emails will be sent here)

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Phone:

Primary Phone*

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Address:

Street # & Street Name*

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City*

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Province/State*

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Postal/Zip Code*

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Date of Birth:*

Day

Month

Year

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Ineligible - You have specified age of .

The age eligibility requirements for this service is:

Warning: Submission may be denied.

Client Health Card Number:

Client Health Card Number

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Version Code

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Language:

What is the preferred Language?

English

French

Other

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Additional Information

What is your ethnicity?:

Why are you contacting us?:*

Notifications:

Send confirmation, change & reminder messages to < name > < email >

Yes

Submission complete

The information has been submitted to Alzheimer Society of Toronto, but you have some steps left:

Save Confirmation
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Summary

Reference #: -

Registrant:
Organization:

Alzheimer Society of Toronto

Service:

Contact an Intake Coordinator

Inquiry Phone:

1 (416) 322-6560

Tip: Referrals can be viewed by navigating to referrals in the top menu

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