*Needs Assessment Family Questionnaire*


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.
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?
3. Do you speak English?
4. What other language(s) do you speak?
5. Who are you most likely to confide in when you are concerned about your health?
6. How comfortable are you in asking for assistance?
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