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

This field is required

Client Information

Client Name:

First name*

This field is required

Family/Last Name*

This field is required

Personal Pronouns:

This field is required

Email Address:*

Email (Confirmation and reminder emails will be sent here)

This field is required

Phone:

Primary Phone*

This field is required

Address:

Street # & Street Name*

This field is required

City*

This field is required

Province/State*

This field is required

Postal/Zip Code*

This field is required

Date of Birth:*

Day

Month

Year

This field is required

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

This field is required

Version Code

This field is required

Language:

What is the preferred Language?

English

French

Other

This field is required

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
Print a handout to give to the registrant.

A confirmation message will be sent to - -

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

Cancel