Self Referral Form

Are you or a loved one experiencing memory loss?

Do you want more information on Mild Cognitive Impairment or dementia?

We can help.

Call the office in your area or submit the form below.

Elgin

450 Sunset Dr. Suite 229
St. Thomas, ON
N5R 5V1
519-633-4396

Middlesex

435 Windermere Rd.
London, ON
N5X 2T1
519-680-2404

Oxford

575 Peel St.
Woodstock, ON
N4S 1K6
519-421-2466

Connect with Us:

Self Referral Form

Quick Links to our available support programs and information:

Support for the Person with Dementia

Support for the Care Partner

Education for the Care Partner

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