Referral Form Family
Making a referral is easy, fill out the form below and let us take care of the rest. You will receive a call from our staff who will create an individualized care plan including education, support and social recreation programs.
![Senior couple filling out a form with an advisor.](/niagara/sites/niagara/files/styles/hero/public/2020-09/referral.png?itok=KGHFNo8Y)
Individuals, family and friends can fill out our online referral form below to get connected to the Alzheimer Society of Niagara Region.