*Needs Assessment Family Questionnaire*

CAREGIVING/LANGUAGE & ACCESSING COMMUNITY RESOURCES

 
The following questions help the Alzheimer's Association meet the needs of the community. Your answers will be kept confidential to the Alzheimer's Association.
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1. Have you or a family member experienced memory loss?
2. How many hours per day of care giving are you providing to your loved one?
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3. Do you speak English?
4. What other language(s) do you speak?
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5. Who are you most likely to confide in when you are concerned about your health?
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6. How comfortable are you in asking for assistance?
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