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Dementia Friends
Part 1: Dementia Friends
Part 2: Dementia Friends
Part 3: Dementia Friends
Part 4: Dementia Friends
Previous Course
Part 4: Dementia Friends
Dementia Friends
Part 4: Dementia Friends
Dementia Friends Post Test
Email
(Required)
(We will not share this email-this allows us to compare pre and post-test):
City
(Required)
State
(Required)
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Enter your state
Zip Code
(Sharing your ZIP code helps us credit your community. This question is optional.)
Organization
What is/ are your personal experiences with dementia: (check all that apply)
(Required)
I am living with dementia.
I am or have been a care partner for someone who is living with dementia.
I am a professional who works with people living with dementia.
I know someone who is living with dementia.
I do not have any experience with anyone living with dementia but want to learn more about it.
Please select true or false for the follow statements below:
Dementia is a typical/ normal part of aging.
(Required)
Select
True
False
Dementia is caused by diseases of the brain.
(Required)
Select
True
False
Dementia is not just about having memory problems. It may affect thinking, communication, and ability to carry out everyday tasks.
(Required)
Select
True
False
There are healthy habits you can adopt to reduce your risk of dementia.
(Required)
Select
True
False
After this Dementia Friends session, on a scale from Strongly Disagree to Strongly Agree, please select the response you feel reflects your feelings about each statement.
I am confident interacting and communicating with people living with dementia.
(Required)
Strongly Agree
Agree
Disagree
Strongly Disagree
It is possible to live well and be engaged with your community with a dementia diagnosis.
(Required)
Strongly Agree
Agree
Disagree
Strongly Disagree
People living with dementia need to feel safe, respected, and included, just like anyone else.
(Required)
Strongly Agree
Agree
Disagree
Strongly Disagree
I am motivated to connect with people living with dementia.
(Required)
Strongly Agree
Agree
Disagree
Strongly Disagree
I am aware of tools and resources in my community to support people living with dementia.
(Required)
Strongly Agree
Agree
Disagree
Strongly Disagree
Which of the following personal actions will you take to create a more dementia friendly and welcoming community for people living with dementia and their care partners? Place a check next to each action you will take. Select as many as you like.
(Required)
Offer support to people living with dementia in your community.
Offer support to care partners of people living with dementia in your community.
Connect with someone I know who is living with dementia.
Volunteer for an organization that offers services and supports for people living with dementia and their care partners.
Make environmental changes to my home and/or workplace to be more dementia friendly.
Encourage my friends and family to become Dementia Friends/ become more dementia friendly.
Incorporate dementia friendly practices into my next interaction with a person living with dementia.
Educate others on effective communication strategies for interacting with people living with dementia.
Join or start a campaign for change in my community (participating in local advocacy events, starting a dementia friendly campaign, etc.)
Volunteer to participate in a clinical trial or research study.
Ask my doctor for a cognitive assessment at my next physical exam.
Get more information about dementia.
Incorporate more brain healthy activities into my daily life.
Select All
Please list three words that you associate with the word “dementia.”
(Required)
Please list any comments or feedback about the Dementia Friends Session that you would like to share.
(Required)
Do we have permission to contact you for a 3-month follow-up survey?
(Required)
Select
Yes
No
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