Speak to An Expert. - Clinical Enrollment

Are you answering this screening for yourself or a loved one? *

Yourself
A love one

Are you between 55-90 years old? *

Yes
No

Is your loved one between 55-90 years old? *

Yes
No

Have you been experiencing mild memory loss and may or may not have been diagnosed with mild cognitive impairment or Alzheimer’s disease? *

Yes
No

Has your loved one been experiencing mild memory loss and may or may not have been diagnosed with mild cognitive impairment or Alzheimer’s disease? *

Yes
No

Do you have a caregiver or partner who can attend all the appointments with you? *

Yes
No

Does your loved one have a caregiver or partner who can attend all the appointments with them? This can be you. *

Yes
No

What is your loved ones full name? *

First

Last

What is your full name? *

First

Last

What is your email? *

What is your phone number? *

Which location is most convenient for you? *

User Agreement By clicking "I accept", you understand and agree to the terms of the Privacy Policy. I understand and agree by selecting the submit button, you give permission to share your responses with the study doctors and staff at the clinical research site that you selected, so that they may contact you to discuss the study further. *

I agree
I do not agree