Make A Playlist

NOTE TO PFL STAFF: I’m working on the back-end of this form so it’s currently inactive – you can fill it in but it won’t do anything! Best, Nick

Playlist for Life can make a playlist for you or someone with dementia you care for and deliver it to you in the most appropriate way for your circumstances. If you would like to receive a playlist please complete this form. 
About you
We need your contact details so that we can contact you about your playlist request and send you the finished playlist. 




Music Detective clues
We need to know a little about the music preferences of the person the playlist is for. If you want us to make a playlist for you then answer the questions yourself. If you want us to make a playlist for someone you care for then please answer the questions in this section on their behalf - if you don't know their preferences already then maybe ask them then fill the form in later when you have their answers.  



Playlist songs
If there are any songs you definitely want on the playlist please list them here. You can enter up to ten songs. To add more just click on the 'Add another song' link.


Notes

Keeping in touch

We would love to keep you updated about the work we do, opportunities to get involved or help us, and the latest news from our research and community networks. If you would like to hear from us occasionally then please give consent below to let us know how we can keep in touch with you. You can change your mind at any time you like.

We take your privacy very seriously. We will always store your details securely. We will use them to provide the service or information that you have requested and to communicate with you in the way(s) that you have agreed to. We promise never to sell or swap your details with anybody else. We may also use your information to help us improve our website and our services. For full details please see our Privacy Policy.

Thank you for requesting a Playlist for Life. Our staff team will review your request and get back to you.