Dementia Registry

This voluntary registry is for individuals diagnosed with Alzheimer’s disease and related dementias.

Please complete the following online form or download the printable form. Additional required paperwork and photos will need to be provided later.

If you have any questions please contact Sergeant Fimbres with the Community Services Division of the Euless Police Department at 817-685-1685. See the Registry Brochure for more information about this program and Alzheimer’s disease.

All information provided will assist with locating your family member and meets State requirements for requesting Silver Alerts.

Participant Information
Medical Information
  1. (A physician's letter will need to be provided.)
  2. (A current photo will need to be provided.)
Vehicle Information
  1. Complete vehicle(s) information accessible to the participant
Cell Phone Information
Credit/Debit Card Access
Family Contact

Additional Information
Additional Emergency Contacts