Memory and Cognitive Function Test *- Better Memory

This simple test will give you a baseline as of today.

1. Do you find you forget people’s names?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

2. Do you find you can’t quite remember something although it’s “on the tip of your tongue”?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

3. Do you start doing one thing at home and get distracted into doing something else (unintentionally)?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

4. Do you have difficulty getting quality sleep?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

5. Do you have difficulty concentrating?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

6. Do you have difficulty with recall?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

7. Do you have brain fog?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

8. Do you read something and find you haven’t been thinking about it and must read it again?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

9. Do you find you forget why you went from one part of the house to the other?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

10. Do you forget where you put something like a newspaper or a book?

0 = Never

1 = Very Rarely

2 = Occasionally

3 = Quite Often

4 = Very Often

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First Name *

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Email Address *

Age

The questionnaire above is a basic memory and cognitive assessment and every person is different. If you wish to receive a free consultation, please provide your phone number and the best time for our specialist to call you to discuss your need. We are here to help.

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