Sign up to receive Alzheimer’s Society Companion Calls

Our Companion Call service connects people affected by dementia with trained volunteers for regular telephone conversations, typically weekly for up to 12 months! These calls offer a safe and welcoming space to simply have a chat—whether it's a favourite TV show, the weather, or about how things are going.

Sign up either for yourself or someone else, the companion call team will contact you to provide further information about the service. All information submitted will be entered into Alzheimer’s Society systems and held securely.

This form is to receive the service. If you would like to volunteer for the Companion Call Service, please visit our Companion Call volunteer page.

To receive companion calls you must:

- Be a person living with dementia or awaiting a diagnosis
- Be a carer of someone with dementia
- Be able to use a telephone to answer calls
- Live in England, Wales or Northern Ireland.

If you would like the referral made for you by a dementia advisor please call our support line on 0333 150 3456

Would you like to sign up for yourself or someone else?

Your contact details

To sign up to Companion Calls for yourself, please enter your own contact details below.

We request your email address and phone number to enable our Companion Call advisers to reach out to you and provide information or assistance related to our service. To find out more about how we use your personal information, please read our supporter privacy statement.

Full name (required)

Address (required)

Enter a UK postcode to look up your address.

If preferred, enter or amend your address below.

Address line 1 (required)

Address line 2 (required)

Town or city (required)

County (required)

Postcode (required)

Phone number (required)

Email address (required)

Date of birth (required)

About you

Do you care for someone with dementia?

Yes (required)

No (required)

Do you have a dementia diagnosis?

Yes (required)

No (required)

Where did you hear about our service? (required)

Why would you like to recieve companion calls? (required)

Anything else you would like us to know? (required)

Contact details of the person you are referring

To sign up to Companion Calls on behalf of someone else, please enter the contact details of the person you are referring below.

We request an email address and phone number to enable our Companion Call advisers to reach out and provide information or assistance related to our service. To find out more about how we use your personal information, please read our supporter privacy statement.

Full name (required)

Please enter the name of the person you are referring.

Address (required)

Enter a UK postcode to look up your address.

If preferred, enter or amend your address below.

Address line 1 (required)

Address line 2 (required)

Town or city (required)

County (required)

Postcode (required)

Phone number (required)

Please enter the phone number of the person you are referring.

Email address (required)

Please enter the email of the person you are referring.

Date of birth (required)

Your own contact details

Full name (required)

Phone number (required)

Email address (required)

About the person you are referring

Does the person you're referring have a diagnosis of dementia?

Yes (required)

No (required)

I don't know (required)

Is the person you're referring caring for someone with dementia?

Yes (required)

No (required)

What is your relationship to the person being referred?

Family (required)

Friend (required)

Carer (required)

Professional (required)

Why does the person you are referring want to recieve Companion Calls? (required)

Where did you hear about our service? (required)

Is there anything else you would like us to know? (required)

Emergency contact details

Full name (required)

Phone number (required)

Sign up to receive Alzheimer’s Society Companion Calls

By ticking this box you consent to the self referral and to being contacted by the team

By ticking this box you confirm you got consent from the person you are referring.

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