Dementia Self-Management PDF Download Form Name(Required) First Last Email PhoneDo you live in Nevada, or provide care and support for someone living with dementia in Nevada?(Required) Yes No Zip Code(Required) How would you describe yourself? (Select all that apply.)(Required) I am a person living with dementia. I am a family member or friend of someone living with dementia. I am a professional who works in the field of dementia support. I am a professional who provides direct care to people living with dementia. I am a healthcare provider. I am a researcher or educator. I am an interested community member. Organization Position/Title Please share a few words about how you plan to use the Dementia Self-Management Guidebook.Would you like to receive monthly DEER Program newsletters? Yes, send me the newsletter! No, I don’t want to receive the newsletter.
