H&F Dementia Strategy - Families/Carers of People Living with Dementia - Page 1 of 4 - London Borough of Hammersmith and Fulham

Personal Details

1. You are

Diagnosed with dementia Worried about dementia Caring for someone living with dementia

If caring for someone with dementia, what year was the person who you care for diagnosed?

2. Do you live in the London Borough of Hammersmith & Fulham?

Yes No

3. Do you care for someone in the London Borough of Hammersmith & Fulham?

Yes No

4. Please leave an email address and choose ”Yes” if you are happy for us to contact you in the future.

Yes No

If yes, please type email address