Participate in a usability study in with Level Access and Cognito Therapeutics

Thank you for your interest in participating in a hour-long User Experience Research session in San Francisco, CA or Boston, MA areas.

The goal of this study is to get feedback on a non-invasive device and a variety of prototypes to slow Alzheimer's disease.

If you might be eligible, you will be contacted for a brief phone call with additional questions and discussion of project details to see if you qualify for an in-person session.

Should you be eligible and complete an interview, a $150 honorarium will be provided to compensate you for your time.

With your participation, you will help us improve potential therapeutics for Alzheimer's disease.

Any information shared in this survey will be kept confidential and shared for the purposes of facilitating the research sessions, not to individually identify you.

If you have any questions, please contact our team at uxresearch@cognitotx.com

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* 1. Participant's Name

First Name:

Last Name:

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* 2. Care partner's name (if applicable)

First name:

Last name:

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* 3. What is your contact information?

Phone number:

Email address:

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* 4. Where do you live?

City:

State:

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* 5. Are you or someone you care for experiencing mild cognitive impairment (also called MCI) possibly due to Alzheimer’s disease? Some possible symptoms include forgetting important information that he or she would previously have recalled easily, such as appointments, conversations or recent events or impairments in the ability to make sound decisions, judge the time or sequence of steps needed to complete a complex task, or visual perception.

Yes

Not sure

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* 6. Are you or someone you care for experiencing MILD changes to memory possibly due to Alzheimer’s disease? Examples include forgetting familiar words, the location of everyday objects, or recently learned information. The person may still drive, work and be part of social activities.

Yes

Not sure

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* 7. Are you or someone you care for experiencing MODERATE changes to memory possibly due to Alzheimer's disease? Examples include forgetting personal information and experiencing confusion about where they are or what day it is, and the person can still participate in daily activities with assistance.

Yes

Not sure

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* 8. Are you or someone you care for experiencing SEVERE changes to memory possibly due to Alzheimer's disease? Examples include losing awareness of recent experiences as well as of their surroundings, having difficulty carrying a conversation and experiencing difficulty controlling movement, and likely requiring daily support for personal care.

Yes

Not sure

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* 9. Have you or the person you care for received a physician's diagnosis of Alzheimer's disease?

Yes