Screening Form

To evaluate your eligibility for the study, please answer the next following 4 questions to the best of your knowledge.

Screening Form

Q1: What is your age?

Screening Form

Q2: What is your education level?

Screening Form

Q3: Any family history of dementia (first degree*)?
*First degree means parents, siblings or children

Screening Form

Q4: Within the last 5 years, have you been prescribed with treatment for any of these conditions?

Thank You!

Thank you for completing the form, this is helpful for us to determine your eligibility for the appropriate studies. We will be in touch with you if you are eligible.

As we are experiencing a high volume of enquiries, we will take longer than usual to get back to you for an appointment. Thank you for your understanding.