Alzheimer’s Foundation of America

Foundation of America

Screening: Data Collection Form

  • MM slash DD slash YYYY
  • Additionally, please upload any completed Voluntary Participant Surveys. If you are having trouble uploading the surveys, please submit them by using one of the following options:
    • Email –
    • Fax- 646-638-1546
    • Mail- National Program Coordinator, 322 8th Ave, 7th Floor, New York, NY 10001

    Drop files here or
    Accepted file types: doc, docx, pdf, Max. file size: 128 MB.