ALZ Young Adult Support Group Survey
WELCOME! Please complete the survey below. Upon completion one of our facilitators, will reach out to you soon!
Email *
First Name *
Last Name *
Address (minus zip code)
Zip Code *
Phone number
Age *
BACKGROUND INFORMATION
Do you know much about Alzheimer's disease or any type of dementia?
Who in your life has Alzheimer's disease or another type of dementia? (choose more than one if appropriate)
How long have you known someone who has Alzheimer's disease or another dementia?
Are you a caregiver of someone with dementia?
How did you hear about this support group?
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