The Maine Dementia Care Partnership, a coalition to improve dementia care co-chaired by the Maine Ombudsman Program, Maine Healthcare Association, and Jabbar Fazeli, MD, has partnered with Memory-Lane.TV, based in Portland, Maine, to provide 60 nursing homes free access to Memory Lane TV, a non-pharmaceutical dementia care intervention, for two years. This form is designed to formalize the registration of your institution.

Please enter the following information

Name of the primary contact person(Required)
This email will serve as the account ID, so it might be different from the contact’s email, or not.
Business Address

Please confirm the following pre-requisites are currently in use/will be installed prior to start of service:

We have broadband internet service at the location where Memory Lane TV will be used.(Required)
Do you currently have a suitable HD or 4K TV in place – ideally in common area in the memory care unit?(Required)
Are you currently using any of the following streaming devices in your facility that can also be used for MLTV (check all that apply)?(Required)

Orientation and Training Webinar Registration

Please ensure your organization’s TV, streaming device, and broadband internet service are all in place prior to the webinar for best results. Once your registration is confirmed, we will send you access to the webinar.
Please select the orientation and training webinar time that is most convenient for you/your team (participation in one of the webinars is recomended to begin service)(Required)
If no one from your team is able to attend any of the scheduled webinar options, please contact us and we will try to accommodate your schedule as best we can
This form is protected by Google Recaptcha. Terms | Privacy
This field is for validation purposes and should be left unchanged.