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Memory

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
Memory
1

What is your age?

Select one answer
2

How would you rate your memory?

1= not good 5= perfect
3

Rate how much being tired affects your memory

1= not at all 5= very well
4

Rate how often you forget daily tasks?

1= never 5= all the time
5

How often do you recall details (exact words, images) from past events?

1= not often 5= very often
6

Provide any feedback you would like to related to this survey.