Direct Connect Rapid Referral
For Alzheimer's disease and other dementias
Direct Connect Rapid Referral is a secure and HIPAA compliant online form that directly links individuals and families to the Alzheimer’s Association for education, caregiver support and customized action plans.
This free service offers your patients the benefit of confidential support and information necessary to successfully navigate the challenges inherent with memory loss, Alzheimer’s disease and other dementias.
Forms available below:
ONLINE REFERRAL FORM
PDF REFERRAL FORM
Once received, the Alzheimer's Association will contact the referred individual within two business days and assist with immediate needs. The Association will continue to serve the client with future needs as they arise. If the client gives permission, we will fax an action report back to you.
For more information contact our 24/7 Helpline at 1.800.272.3900