Initial Survey
Alzheimer's Spectrum Foundation's goal is to raise awareness about all the symptoms that occur with Alzheimer’s disease and other illnesses and shed light on the connection racial, ethnic and socio-economic factors that contribute to the onset and progression of Alzheimer’s disease.

This survey will collect real-world data about other illnesses interacting with Alzheimer’s disease and examine the connection to racial, ethnic and socio-economic factors that may contribute to the onset and progression of Alzheimer’s disease.

This data will be key in helping underrepresented groups of people impacted by Alzheimer's/dementia, by shedding light on the connections that racial, ethnic and socio-economic factors play in communities previously underrepresented in Alzheimer's/dementia research.
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Do you or someone you're caring for have Alzheimer's/Dementia? *
How long have you or your loved one been dealing with Alzheimer's/dementia? *
What is the race and/or ethnicity of the person dealing with Alzheimer's/dementia? *
What is the sexual orientation of the person dealing with Alzheimer's/dementia? *
What is the gender orientation of the person dealing with Alzheimer's/dementia? *
Does the person dealing with Alzheimer's/dementia exercise during the week? *
Have you or the person dealing with Alzheimer's/dementia ever served in the military? *
Required
Do you or the person dealing with Alzheimer's/dementia own a gun? *
Does the person dealing with Alzheimer's/dementia have any other illnesses/ comorbidities (other than Alzheimer's/ dementia)? *
Required
Does the person dealing with Alzheimer's/dementia take any medications for Alzheimer's or other illnesses? *
Contact Information
Please enter the following information, if you would like to be contacted for further questions/information.
Phone Number
E-Mail
We welcome any comments or feedback
Consent
Any information that is obtained in connection with this survey/study and that can be identified with the person this survey/study pertains to will remain confidential. By clicking Submit, you consent to the use of the information submitted in this survey/study.
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