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Memory
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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Memory
1
What is your age?
Select one answer
20 and under
21 and up
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.
Submit