Online Screening Name & Surname(required) Please complete the following for us to better understand your medical need. Age between 20 - 30 Age between 31 - 40 Age Between 41- 50 Age between 51 - 60 Age between 61 - 70 Age between 71 and older My health is good My health is average My health is poor I am on chronic medication I suspect I might have Alzheimer's disease. I have the following symptoms I would like to be a medical trial volunteer Yes No Contact Number(required) If your answer to the previous question was no, please tell us how you would like for us to assist you? Your email address(required) Share this:Click to share on Twitter (Opens in new window)MoreClick to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window)Click to print (Opens in new window)Like this:Like Loading...
