ALZHEIMER'S AND DEMENTIA

Herbert Protocol Form

People with dementia sometimes get lost and go missing. If you care for someone with dementia you can fill in this form containing information to give to the police if the person goes missing. This means you don’t have to remember the information when you are under stress if someone goes missing. And it saves time, so the police can start the search sooner. You can fill in this form on your computer or print it out and fill it in by hand. Keep it somewhere safe where you can easily find it if the person goes missing. You could give a copy to friends, family and neighbours. Keep this information up to date whenever something changes. You only need to give the form to the police if the person goes missing. Details are helpful, but don’t worry if you can’t answer every question. There is space at the end of the form to tell us more if you run out of space for any of the questions. And you can always add another page to a printout or add something to an email.

Download Form

For more information about Alzheimer's and dementia, please visit the Alzheimer's Society of Ireland website below:

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