Discovering Dementia Group Information Form

Discovering Dementia - Group Information Form
Group Name
Main Contact and Phone Number
Where do you currently meet?
When do you meet? Include day/s and time/s
Tell us a bit more about your group and what you do!
Share with us an image you would like us to use to publicise your group

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The following information will not be shared publicly but we're keen to see how we can best support your group and identify any gaps across the county
Are you a constituted group?
In an ideal world, what would your group have in place to be the best it can be?
Who typically attends your group?

Pre diagnosisPeople with Young OnsetEarly stagesMid stageLater stageCarersBereaved carers
Of the above, give us a rough percentage for each category
Anything else you would like to share with us?
Should be Empty:

Discovering Dementia - Group Information Form