Caregiver Support Group Request "Required" indicates required fields NameRequired First Last PhoneRequiredEmailRequired Where would you like to attend a support group?RequiredBurlingtonHalton HillsMiltonOakvilleVirtualWho are you caring for?RequiredSpouse or PartnerParentOtherWhat condition is the person you care for living with?RequiredDementiaAnother illness, disability or reason they require careLanguages SpokenHow should we contact you? Telephone Email Permission to SubmitRequiredAcclaim Health is committed to individual privacy and has taken reasonable precautions to ensure the security of the information you are submitting through this online form. By clicking “I agree” you are acknowledging and accepting the potential risks inherent in submitting personal information and/or personal health information online. Please contact us by telephone at 905-827-8800 if you do not wish to submit this information online and we will be happy to assist you. I agree CAPTCHA