Cognito User Experience Research Interest Form Hello, Thank you for your interest in participating in Cognito research. We recognize the complexities of day to day life with Alzheimer's Disease. Our aim is to develop a treatment that recognizes these realities and supports individuals and caregivers throughout the journey. To make this mission a reality, we work closely with the individuals we are designing for to root ourselves in their evolving needs and challenges. Below you'll find a short form. Thank you for joining us in our efforts to tackle this devastating disease. If you have any questions or would prefer to fill out this form by phone, please reach out to the team at UserExperience@cognitotx.com or (888) 515-3039. We are particularly interested in connecting with individuals dealing with issues related to memory loss, including: Individuals concerned about memory loss (family history of Alzheimer’s, ApoE4 positive, or other) Individuals who have been diagnosed with Mild Cognitive Impairment (MCI) Individuals who have been diagnosed with Alzheimer’s (early to moderate stage) Caregivers and Care Partners for individuals dealing with memory loss or Alzheimer’s Disease Health care providers currently or recently working with individuals with MCI or Alzheimer’s Disease Thank you for helping us share this research opportunity with others who might be interested in sharing their story and perspectives. Please note your survey responses will remain confidential. Best,The team at Cognito Therapeutics OK Question Title * 1. What is your first name? OK Question Title * 2. What is your gender? Female Male Other OK Question Title * 3. What is your date of birth? Date / Time Date OK Question Title * 4. What city and state do you live in? (please note city and country if outside of the US) OK Question Title * 5. At what email address would you like to be contacted? OK Question Title * 6. What phone number is easiest to reach you at? OK Question Title * 7. What interests you about participating in our research? I am struggling with memory issues, but haven't been diagnosed with dementia I have been diagnosed with Mild Cognitive Impairment (MCI) I have been diagnosed with Alzheimer's disease (early to mid-stage) I am a caregiver for someone with (early to mid-stage) Alzheimer's disease I work with individuals diagnosed with memory loss, dementia, or Alzheimer's disease I have a family history of Alzheimer's or dementia Other (please specify) OK Question Title * 8. What types of research might you be interested in participating in? Translational research (Greater Boston residents only) At-home studies In-depth Interviews (1-2 hour conversations) Surveys Feedback on Cognito devices, packaging, and other ideas in development Brainstorm Sessions - generating ideas to address needs Prototyping sessions - building, developing ideas Cognito clinical studies Other (please specify) OK Question Title * 9. How did you hear about our survey? Newspaper Ad Cognito Website Family or friend member Cognito employee Twitter Facebook Cognito Email Newsletter Other (please specify) OK DONE. THANK YOU. WE WILL BE IN TOUCH.