Referral Forms


Referral Form: Find our Self-Referral and Professional Referral Form Here


We are here to help. Contact our office at 1-800-561-5012 or by emailing [email protected]

Health Professionals

If you are a Healthcare professional and would like to make a referral, please:

  1. Ask your patient or their family member’s permission to forward their name to the Alzheimer Society.
  2. Then, fill out the First Link®  Referral Form and return it to the Alzheimer Society Huron Perth.
  3. Find out more about our First Link® Program here.

Self Referral 

If you are concerned that you may have dementia, or have been recently diagnosed and are unsure what your next step is, we can help you get the information you need.

Remember, dementia is not a normal part of aging.

  • If you are concerned about any of the early warning signs, talk to your doctor.
  • You know your body and you should speak up if you have worries about Alzheimer’s disease or other dementias.
  • Our list of 10 warning signs can help you identify the signs of dementia.

For help and support with self-referral, please contact us