Next Generation Alzheimer's Informal Survey
I have questions about other people's experiences with Alzheimer's and other forms of dementia. Thank you for sharing yours with me.

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Willing to be interviewed for my upcoming book?

Fill out the interview form here: https://forms.gle/yYpdwVhQjtUdUjc1A

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Your name (first and last - optional)
Your email address (optional)
If you entered your email address, would you like to opt-in to updates about the book and other Next Generation Alzheimer's events?
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City, State, Country where you live *
If someone referred you to this form, please let me know who that was:
Your Gender
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Your race
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Age range *
Do you have a biological parent or grandparent who suffered or is suffering dementia? *
Have you ever been asked at a primary care visit about your family's history of Alzheimer's and other forms of dementia? *
What factors do you believe cause dementia? Check all that apply. *
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Approximately how many Americans do you think suffer Alzheimer's currently? *
Please share anything you'd like to here about your experience or questions about Alzheimer's and other forms of dementia.
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