Want to Join a Study?

Just a few questions can help us get you closer to participating in one of our trials

Answer These Questions

Take a few minutes to answer these few questions in order for us to determine whether you might be a candidate for one of our trials

1. What is your relationship to the patient?

2. How long has the patient been diagnosed with Probable Alzheimer's Disease, and would you say the memory loss could be classified as mild, moderate or severe?

3. Is the patient currently living with cancer or has had cancer in the past?

4. Has the patient ever had a stroke or a major head injury?

5. Please list all medications the patient is currently taking.

Please provide your answers to these five questions below, as well as a good contact number where you can be reached so that we may call you regarding your participation in one of our studies.

name

email address

contact phone number

patient information

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