Does someone in your home suffer from dementia, confusion or memory loss?

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* 1. Does someone in your home suffer from dementia, confusion or memory loss?

Do you care for that person, for instance by helping them dress, get to appointments, or eat?

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* 2. Do you care for that person, for instance by helping them dress, get to appointments, or eat?

Does anyone else in your home also care for that person?

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* 3. Does anyone else in your home also care for that person?

Are you sometimes able to safely leave the person at home alone?

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* 4. Are you sometimes able to safely leave the person at home alone?

Are you interested in attending a support group to hear what others have done in that situation, or to learn more about available resources?

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* 5. Are you interested in attending a support group to hear what others have done in that situation, or to learn more about available resources?

What topics are of interest to you?

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* 6. What topics are of interest to you?

The group meets once a month. What day(s) and time(s) are best for you to attend a meeting?

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* 7. The group meets once a month. What day(s) and time(s) are best for you to attend a meeting?

Any additional comments you'd like to share with us to make this a better group? 

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* 8. Any additional comments you'd like to share with us to make this a better group? 

Would you like us to contact you about visiting the support group?

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* 9. Would you like us to contact you about visiting the support group?

Please give us your name and contact information if you would like more information about the group.

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* 10. Please give us your name and contact information if you would like more information about the group.

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