Today's Date Program Date* Program Name*Caregivers of Persons with Dementia (Prairie Grove, 1st Tue.)Caregivers of Persons with Dementia (Bella Vista, 1st Thu.)Caregivers of Persons with Dementia (Rogers, 2nd Wed.)Caregivers of Persons with Dementia (Springdale, 2nd Thu.)Caregiver Support Group (Eureka Springs, 2nd Tue.)Caregivers of Persons with Dementia (Fayetteville, last Mon.)Persons living with Parkinson's Disease and their Care Partners (Eureka Springs, 1st Wed.)Persons living with Parkinson's Disease and their Care Partners (Rogers, 3rd Tue.)Caregivers of Persons with Dementia (Virtual, 3rd Tue.)Caregivers of Persons Living with FTD (Virtual, 3rd Tue.)Peer Support for Persons Living with Early Stage Dementia (Virtual, 1st Tue.)What topics would you like to see addressed in this program?Begin on a new line and number each new topic. What goals do you want to accomplish by participating in this program?Begin on a new line and number each new goal. Has this program positively impacted your life?* Yes No Cannot say Please share any examples of the positive impact on your life.Begin on a new line and number each new example. Please share program changes you suggest to have a positive impact.Begin on a new line and number each new changes. Are there other comments you would like to share about this program?Begin on a new line and number each new comment.
