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Fax Referral
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The Memory Loss Fax Referral Program is designed to assist the health care provider with patients and their families diagnosed with memory loss, Alzheimer’s disease and other dementias. Caregiver education and support has been demonstrated in clinical trials to improve patient function and to delay the need for nursing home/long term care placement (references available upon request).

This program can save you time and money. The program allows the provider’s staff to complete a simple one-page, HIPAA compliant form and fax it to the Alzheimer's Association for referral services.

For more details, click here to view our letter with our full invitation for your participation.

Our Fax Referral Form is here for you to print and use.

If you have any questions, please call Annie Marrs at 434-973-6122 or email her at


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Alzheimer's Association

Our vision is a world without Alzheimer's
Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research.