Join Us or Refer Someone to Us

Many of our services, such as our support groups, require membership. If you would like to join, or would like to refer someone to us, all you have to do is fill in as much of the form as you can manage, click the submit button and a member of our staff team will be in touch.’.

And there's nothing to pay - Silverline Memories is funded entirely via sponsorship funding and donations.

 

Referral form

  • Section 1

    Information about the person you are referring
  • DD slash MM slash YYYY
  • Please include post code
  • e.g. vascular dementia, Alzheimer’s etc.
  • Section 2

    Information about the person making the referral (if you are self-referring please write n/a and go to section 3)
  • Please include post code
  • DD slash MM slash YYYY
  • Section 3

    Additional Information about the person named in Section 1
  • Such as Social Worker, Care Agency, etc.
  • Such as behaviours, symptoms, mood, emotional state, day-to-day life, family circumstances, etc. It can also be helpful to include information about their previous occupation, hobbies, interests, etc.
  • In an emergency who would this person like us to contact?

  • Finally...

  • This field is for validation purposes and should be left unchanged.

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Are you thinking about writing or changing your Will?  You can do it completely for free by visiting the Free Wills site.

And if you include a pledge in your Will to Silverline Memories, no matter how small, you can keep helping us to improve the lives of people with dementia.

 

Silverline Memories, 177B Kirkwood Drive, Kenton Retail, Newcastle upon Tyne, NE3 3BE

Registered charity no 1163582

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