Symptoms Checklist Website Page

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1. I describe myself as: (Required.)

A person living with mild cognitive impairment or dementia

A family member, friend, or care partner

A professional, please explain:

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2. How helpful do you find the Symptoms Checklist? Please rate it on a scale of 1 to 5, with 5 being the most helpful. (Required.)

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3. Would you recommend The Symptoms Checklist to a friend? (Required.)

Yes

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4. Please provide any comments or feedback.

Please click here (https://dementiaminds.org/donate/) if you would like to make a donation to the National Council of Dementia Minds which is a 501 (c) 3 non-profit organization.

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5. Would you like to join our email list? If yes, please provide your information below.

First Name

Last Name

State

Symptoms Checklist Website Page

Question Title

* 1. I describe myself as: (Required.)

Question Title

* 2. How helpful do you find the Symptoms Checklist? Please rate it on a scale of 1 to 5, with 5 being the most helpful. (Required.)

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* 3. Would you recommend The Symptoms Checklist to a friend? (Required.)

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* 4. Please provide any comments or feedback.

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* 5. Would you like to join our email list? If yes, please provide your information below.

1. I describe myself as: (Required.)

2. How helpful do you find the Symptoms Checklist? Please rate it on a scale of 1 to 5, with 5 being the most helpful. (Required.)

3. Would you recommend The Symptoms Checklist to a friend? (Required.)

4. Please provide any comments or feedback.

5. Would you like to join our email list? If yes, please provide your information below.