Dementia Together Education - QR Code

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* 1. Contact Information

Name

ZIP/Postal Code

Email Address

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* 2. Date of Training

Date

Date

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* 3. I am taking this class as a...

Health Care or Senior Care Professional (taking this class as part of your job)

First Responder

Family/Friend Care Partner

Community Member

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* 4. Do you feel more confident now than before this session to promote well-being for loved ones/clients/residents/people living with dementia?

Yes

No

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* 5. Did you gain helpful insights to effectively interact with loved ones/clients/residents/people living with dementia?

Yes

No

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* 6. What was the most helpful insight for understanding someone living with dementia?

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* 7. What will you do differently as you apply what you have learned today?

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* 8. What one word comes to mind after participating in this session?

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* 9. Additional comments, questions, request.