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The Memory Loss Fax Referral Program -

The Memory Loss Fax Referral Progam is designed to assist the provider with patients and their families diagnosed with memory loss, Alzheimer’s disease and other dementias. Caregiver education and support has been demonstrated in clinical trials to improve patient function and to delay the need for nursing home/long term care placement (references available upon request).

This program can save you time and money. The program allows the provider’s staff to
complete a simple one-page, HIPAA compliant form and fax it to the Alzheimer's Association
for referral services. The form is attached, for your duplication/use.

Download the Memory Loss Fax Referral Letter

Download the Memory Loss Fax Referral Form

HOW THE PROGRAM HELPS YOU AND YOUR PATIENTS BY PROVIDING CAREGIVER EDUCATION

  • Patients and caregivers dealing with a diagnosis of dementia are connected with needed resources and support
  • Education and support services help create a healthy, informed patient and caregiver
  • Families receive a timely response
  • Patients and families receive help understanding the impact of dementia on the individual and family
  • Families get the opportunity to build a support network early in the disease process

ALZHEIMER’S ASSOCIATION PROGRAMS

  • 24/7 Toll Free HelpLine with trained counselors 800.272.3900
  • Care Consultations – in person visits to provide education, access to resources and support
  • Support Groups
  • Educational Programming, including Early Stage Resources and Programs
  • Resource Library
  • MedicAlert