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Register for the Dementia Safeguarding Scheme

Use this form if someone you know has dementia or is awaiting diagnosis and you would like to provide the police with information to help in the event of the person going missing.

If you are concerned about your friend or relative, call the police on 999.

If you have already registered someone for the Dementia Safeguarding Scheme (Herbert Protocol) and want to update their details, report a change of circumstances.

Once you have started the form you will not be able to leave it and return, so make sure you have the time and information to be able to complete it in one go.

This form will take about 25 minutes to complete.

Start now

To fill in this form

You need:

  • date of birth and a general description of the person with dementia
  • names of next of kin and credible neighbours

You will be asked to provide the following about the person, if appropriate:

  • a recent, clear image of the person to upload
  • current address and phone number of the person
  • previous addresses and employer details
  • medical conditions, medication and GP details
  • weekly routines
  • details about the local area - local public transport, premises with CCTV, banks, shops and pubs