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Register and Join our Community
Please register and join the CarePartners Initiative community. The information you provide will be used to tailor our communications and newsletters to you.
Thank you very much for being a part of our community.
Contact Information
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Last Name
Email
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English
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Address
Address Line 1
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Please select the best description that applies to you:
I am a caregiver of someone who has cognitive decline, dementia, or Alzheimer's disease.
I have patients or clients who have cognitive decline, dementia, or Alzheimer's disease.
I have a general interest in this topic.
I am a caregiver for:
My wife/partner
My husband/partner
My mother
My father
My grandmother
My grandfather
Other relative
My friend
My client
I am interested in offering the following activities to my care receiver:
Art therapy
Music therapy
Pet visits
Exercise (walking, gentle yoga, etc.)
My profession is:
Doctor/physician
Nurse
Dentist
Mental Health Professional
Physical or Occupational Therapist
Attorney
Home Care Provider
Spiritual Leader
Business Administrator
Business Owner
My specialty is:
I am interested in referring my patients or clients to CPI:
Yes
No
I am interested in knowing more about the following:
Support groups
Respite care (adult day care)
Caregiver education
Activities and events for care partners (myself and my care receiver together)
Other community resources
Clinical trials
How did you hear about us?
Please include names of people we should thank for referring you to us.
