Brain Function Survey
Please answer the questions and will email you the results of the survey.
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Watson Psychological Health Center Brain Function Questionnaire

 Do you find yourself having to write things down so that you don’t forget to do things?

1 point
Clear selection
Are your often times miss placing things (wallet, keys, purse)?
1 point
Clear selection

Is reading and math becoming more difficult to do in your head?

1 point
Clear selection

Do you find yourself struggling with focus during long conversations or meeting?

1 point
Clear selection

Do you find yourself getting more frustrated with mental tanks that you felt that you use to be able to do, but now can’t?

1 point
Clear selection

Is it more difficult to remember someone’s name after an initial introduction?

1 point
Clear selection
Are learning new task fearful or overwhelming?
1 point
Clear selection

Are you having a difficult time staying on task after an interruption?

1 point
Clear selection

Are finding yourself struggling to follow the theme of stories, movies, or conversation?

1 point
Clear selection

Do you feel that your long term memory is better than your short term memory?

1 point
Clear selection

Do you get less than 8 hours of sleep?

1 point
Clear selection

Do you feel that your diet is high in bad fats? (trans fats are processed fats, butter, chips,  french fries. IF you don’t know then you probably are!)

1 point
Clear selection

Do you feel that details become hard to remember or fuzzy?

1 point
Clear selection

Are you doing some type of exercise at least one time a week?

1 point
Clear selection
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