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Welcome!
Saturday, October 14, 2023
Cornerstone Community Baptist Church
HEAL Collaborative
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Name
*
Your answer
Age
*
18-30
31-40
41-55
56-70
Over 71
Ethnicity
*
African-American
White/Caucasian
Asian/Pacific Islander
Latin/Hispanic
Native American
Other:
Gender
*
Male
Female
Email address
Your answer
Phone number
*
Your answer
Are you a member of Cornerstone?
*
Yes
No
Have you or a loved one been diagnosed with Alzheimer’s or Dementia?
*
Yes
No
Are you a caregiver?
*
Yes
No
Do you have a primary care doctor?
*
Yes
No
Have you ever had a brain health scan?
*
Yes- I've had a brain scan for Alzheimer's or Dementia
Yes- MRI, CT and/or PET
No
How would you rate your current knowledge about Alzheimer’s and Dementia?
*
Extremely knowledgeable
Knowledgeable
Somewhat knowledgable
Not knowledgeable
What are you hoping to learn today?
*
Your answer
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