Pre-New Dementia Diagnosis Workshop Survey What is today’s date? * (MM/DD/YYYY) Enter your birthday * (MM/DD/YYYY) First * First Last Last Phone Email * My understanding of dementia is * Excellent Good Fair Poor My understanding of where to find help and resources related to a dementia diagnosis is * Excellent Good Fair Poor My level of stress as it relates to knowing how to manage a dementia diagnosis is * High Moderate Low No stress We would like to follow up with you 30-45 days after this program. * Yes, you may follow up No, do not follow up If you are human, leave this field blank. Submit
