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Neuroaugmentation & Cognitive Wearables Survey (for Patients)

Instructions

This survey asks about your cognitive challenges and your interest in wearable technology that could help you and patients like you.

This survey consists of 6 (six) sections and should take about 15-25 minutes to complete.

If you need assistance completing this survey, a caregiver may help you read questions and record your answers, but responses should reflect YOUR experiences and preferences.

Required questions are marked with an asterisk (*).

Demographics & Background Information

Please complete this brief section to help us better understand who is participating in our survey.

Basic Information

Age Group

A
B
C
D
E

Gender

A
B
C
D

Education Level

A
B
C
D
E

Geographic Region

Condition Information

Primary Neurological/Cognitive Condition (select all that apply)

My condition is not listed, it is (type):

Time Since Diagnosis

A
B
C
D
E
F

Current Stage of Condition

A
B
C
D
E

Progression of Condition

A
B
C
D
E
F

Living & Care Situation

Current Living Arrangement

A
B
C
D
E
F

If Other, what?

Primary Caregiver

A
B
C
D
E
F
G
H
I

If Other, who?

Level of Daily Assistance In my daily life, I require:

A
B
C
D
E