Have You Been Diagnosed With Mild to Moderate Alzheimer's Disease or Mild Cognitive Impairment?

Consent to Continue

After completing this brief questionnaire more detailed information will be given to you before you decide whether or not to take part in this treatment, and you will have the opportunity to speak with and ask questions of a team member. You can stop this interview at any time.

Please note that by completing this questionnaire, you consent to us collecting your answers to the questions, including your contact information. All information you provide in this questionnaire will be held in strict confidence, and shared only with the centre conducting this treatment. Trialfacts will delete your information from our records upon your request. While completing the questionnaire you will have the option to join our mailing list to be contacted via email about other treatment options or clinical trials for which you may be eligible. You will not be contacted about other treatments or future trials if you choose not to sign up to our mailing list.

For your reference, please find a link to the Trialfacts Privacy Policy.

Are you willing to continue? *This question is required.