Quick Question: November 2025 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.How has FTD affected physical abilities such as walking, balance, or coordination? Not affectedSlightly affectedModerately affectedSeverely affectedNot sureWhat types of physical therapy or mobility aids have you used? (Select all that apply)Physical therapyOccupational therapyWalking aids (cane, walker)Wheelchair or scooterNoneOtherMobility AidsWhat types of physical therapy or mobility aids would like to try? (Select all that apply)Physical therapyOccupational therapyWalking aids (cane, walker)Wheelchair or scooterNoneOtherOther Mobility AidsPlease Identify yourself: A person diagnosed with FTD, answering for myselfA biological family member, answering on behalf of an FTD-diagnosed personA spouse, answering on behalf of an FTD-diagnosed personA caregiver, answering on behalf of an FTD-diagnosed personA friend, answering on behalf of an FTD-diagnosed personA biological family member, answering for myselfA spouse, answering for myselfA caregiver, answering for myselfA friend, answering for myselfOther...Identify yourself - Please specifyWhat part of the FTD journey are you and your loved one currently on?Select OneNewly diagnosed or mild cognitive declineMid-stage or moderate cognitive declineLate stage or severe cognitive declineMy FTD diagnosed loved one has passed onYour Gender:Select OneFemaleMaleNon-BinaryPrefer not to answerSubmit
