Alzheimer Society of Durham Region--Ontario, Canada




Information Packages can be sent only to addresses in Ontario

Would you like to learn more about Alzheimer Disease, Alzheimer Society of Durham Region and its services? Complete our Information Package Request Form to receive a brochure and fact sheets on a wide range of topics. Alzheimer Society of Durham Region does not share contact information with any third-party. To find out more about how the Society uses information, view our Privacy Policy page or contact Joan Skelton. For regular mail packages will arrive within 5-10 business days.

Name:	*
Address:	*
City:	*
Province:	*
Postal Code:	*
Phone:
E-mail:	*
Date of Birth: (month/day/year)

Would you like family support staff to phone you to discuss what types of information will best meet your needs?

Yes No

How would you like to receive your information?

E-mail Regular Mail

Would you like information sent in an unmarked envelope?

Yes No

Please select which information package suits your needs:

General Information on Alzheimer Disease and dementia
Information on Caregiving
Information for people with dementia
Drug / Treatment for Alzheimer Disease
I require additional information on:


(* denotes required field)