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Trusted Life Circle (TLC) – Beta User Application Form

Thank you for your interest in joining the TLC Beta Program. Please fill out the information below so we can better understand your caregiving experience and ensure TLC is a good fit for your family.
Your Name(Required)
Your Email Address(Required)

About the person you help support:

Have they received a formal dementia diagnosis?(Required)
If yes, what type of dementia has been diagnosed? (Check all that apply)(Required)
On a scale of 1–5, how ingrained are their smartphone habits?(Required)
(1 = Rarely uses a phone, 5 = Uses it daily and frequently)
Your relationship to this person you help support:(Required)

What type of phone does this person have?(Required)
What type of phone do you have?(Required)
Would you be interested in helping provide feedback on TLC during testing?(Required)
How did you hear about TLC?
Terms and Conditions(Required)
By signing below, I acknowledge that I am voluntarily applying to participate in the Trusted Life Circle beta testing program. Participation is not required, and my feedback or app use is 100% optional. TLC will not collect or share any personal data; our only goal is to receive constructive feedback to better meet the needs of individuals with dementia and their families.

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