Please note: The PDF forms are only compatible with Internet Explorer (later than IE8), FireFox and Opera.
- Fax Referral Form – fax to us at 613-523-8522
- Online Referral Form – fill in directly on PDF and click on button to send
- Premiere lien : Formulaire de renvoi
Additional information such as: diagnosis, date of diagnosis, addresses, date of birth, etc. is appreciated but not required.
Family Physician Referral Kit: Please contact First Link Coordinator to receive your referral kit today.
Each family you refer will receive:
- A phone call from the First Link coordinator within 4 weeks
- An information package
- Information about learning series and support programs
- Regular mailings of First Link programs and services
Referring clients to First Link:
- Ensures that families are connected early to education, support and services.
- Helps to reduce overall incidence and intensity of caregiving crisis situations.
- Helps to strengthen the link between diagnosing family physicians, the Champlain Dementia Network and community service providers
- Helps to increase effective and efficient use of community resources
You can refer any client with Alzheimer’s disease or other dementias and their family. Referrals are accepted by phone, fax or email. Please contact the First Link Coordinator with:
- Name of person with dementia
- Name of contact person & relationship
- Phone number of contact person
Dementia Newsletter for Physicians
Information about clinical care, education and research on patients with memory loss. Current and past issues posted on the Champlain Dementia Network’s website at www.champlaindementia.org Disponible en français.
For more information: Contact Joanne Maika-White, Program Staff Alzheimer Society of Ottawa and Renfrew County. Phone: 613-523-4004 ext. 134 Fax: 613-523-8522 Email: email@example.com
For Physicians — New Alzheimer’s Dementia Online Course
This case-based learning module follows the experiences of a primary care patient dealing with progressive dementia. Accredited for 2 Mainpro M1 credits, and MOC Section 1. Be sure to visit the Physicians page on the Champlain Dementia Network to see all the resources available to you.