Your personal story about how we helped you or your family can inspire others to also reach out to us for similar support (like attending a local support group or education program; accessing online resources; calling the 24/7 Helpline; scheduling a counseling session; etc.).

* 1. What concerns did you or your family have that led you to us?

* 2. What help did you receive from us?

* 3. How has this help impacted you or your family?

* 4. Do you hereby give the Alzheimer’s Association permission to use your testimonial, in part or in its entirety, for future promotional purposes (including, but not limited to, chapter website, Facebook, Twitter, eNews, donor thank you letters, year-end giving campaign and annual report)?

* 5. Name

* 6. Email

* 7. Phone

If you have questions or anything additional to share, please email us at