Cognitive Wellbeing Assessment Survey
Please answer the following questions to help us understand your cognitive wellbeing.
How often do you feel mentally sharp and alert?
*
Always
Often
Sometimes
Rarely
Never
How would you rate your memory over the past month?
*
1
2
3
4
5
Do you have difficulty concentrating on tasks?
*
Never
Rarely
Sometimes
Often
Always
How frequently do you engage in activities that challenge your thinking (e.g., puzzles, reading)?
*
Daily
Several times a week
Once a week
Rarely
Never
Please describe any cognitive challenges you have experienced recently.
Submit
Should be Empty: