Interested in Participating?

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Please fill out the information below and if you are eligible to participate, we will contact you to provide additional information about the research.

First Name *

Last Name *

Email Address *

Phone Number *

Are you older than 65? *

Yes

Have you experienced (or others noticed) changes in your cognition? (For example, short term memory gaps, decreased focus or ability to multitask, difficulty in new or unfamiliar situations, names or words hard to recall, self-limiting some daily activities) *

Yes

Do you live in the community (non-institutional setting)? *

Yes

Do you leave home multiple (3 or more) times a week? *

Yes

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