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.

Please note: Due to a significant increase in self-referrals, our estimated response time is currently up to 30 business days.

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

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Self-referral Form

Quick Links to our available support programs and information:

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