Exit this survey
Imperial College Stem Cell Therapy Questionnaire - Alzheimer's Disease
1. About You
Before finding out what you know about stem cell therapy, we'd like to know a bit about you. All data collected here is anonymous and securely stored.
. Please enter your date of birth.
Please enter your date of birth. - Day
. Are you male or female?
Are you male or female?
. What is your ethnicity?
Gypsy or Irish Traveller
Other White Background
White and Black Caribbean
White and Black African
White and Asian
Other mixed/multiple ethnic background
Asian/Asian British Indian
Asian/Asian British Pakistani
Asian/Asian British Bangladeshi
Asian/Asian British Chinese
Other Asian background
Black/Black British African
Black/Black British Caribbean
Other Black background
Any other ethnic group
Rather not say
What is your ethnicity?
If other ethnic group has been selected, please specify
. Which town/city do you live in?
Which town/city do you live in?
. Approximately how long have you been living with Alzheimer's Disease?
Approximately how long have you been living with Alzheimer's Disease?
Less than a year
Longer than 10 years
N/A I'm answering on behalf of someone with Alzheimer's Disease
If answering on behalf of someone else, what is your relationship to the person with Alzheimer's Disease?
. How much does having Alzheimer's Disease impact on your quality of life?
How much does having Alzheimer's Disease impact on your quality of life?
Not at all
Quite a lot
. How often does having Alzheimer's Disease affect your life?
How often does having Alzheimer's Disease affect your life?
All the time
Less than monthly
. Do you suffer from any other medical conditions?
Rather not say
Do you suffer from any other medical conditions?
If yes, please give details of these conditions.
Check out our
and create your own now!