Dementia Safeguarding Wristband form

If you live with dementia, or are a carer or relative of someone with dementia or awaiting diagnosis, you can request a wristband which stores electronic information about the wearer such as their name and next of kin. The device can be scanned by emergency services, or by a person assisting them, if the individual is found lost or in distress. Please note, it is not a tracking device.

The information you provide here will go to Beyond Dementia. A member of the team will be in touch very soon.

As this is currently a pilot, we would ask that you also complete the additional details about the wearer of the wristband in order to help us evaluate the effectiveness of the scheme. If the scheme is successful, this data will also be vital in ensuring future funding is committed to continuing the service.

Who are you completing this form for? *
About you
DD/MM/YYYY
About you
About you
About the person you are referring
Carer information