Quick Form

Dementia (without Photo)

Leave blank any fields you don't want included. We'll do our best to include all of your information but please be aware that space is limited.

Once we receive your information, we aim to have your uCardit ready to view within 2 working days. We'll then send you an email (to the address submitted at registration) to let you know when it's in your 'Saved Cards' folder.

Front of uCardit Text:
Name		to be displayed on the uCardit
Date of birth
Resident
Contact		who and how to contact in an emergency
NHS No
Doctor		name, surgery, contact number?
Free Text		any additional information
Back of uCardit Text:
Default text	I have: Dementia My illness means I may: Be confused Have memory loss Get disorientated Misplace things Get distressed Have problems making myself understood If I appear very distressed or confused please ring a contact on the reverse of this card. Thank you for your help and patience. NHS Direct - 0845 4647

personalised plastic cards

Quick Form

Dementia (without Photo)