Alzheimer’s Emergency Contact Form
Mount Airy Police Department
Places he/she might go to (example: frequent or familiar places, church, stores, etc.)
People he/she might go to visit or turn to
Other names he/she may go by
Vehicles he/she might have access to
Has he/she ever had this type of behavior before and if Yes, when
Any further information that you feel might be pertinent if he/she is lost or missing
Some helpful tips:
10 Signs of Alzheimer’s
ry loss that disrupts daily life.
2. Trouble planning or solving problems.
3. Difficulty completing familiar tasks.
4. Confusion with time or place.
5. Trouble with images and distance.
6. New problems with speaking or writing.
7. Inability to retrace steps.
8. Decreased or poor judgement.
9. Social withdrawal.
10. Changes in mood and personality.
are various options that are available to track physical locations such as wristbands,
cell phones, pocket finders and many more to keep your loved one safe.
Thank you for submitting your information. If any information changes or needs updated,
please contact us at 301-829-1424 or you may email firstname.lastname@example.org.