Quick Question: Tester Page Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.We appreciate perspetives from all those impacted by FTD and understand that some people identify with more than one role. If you identify with more than one role, you are welcome to complete the Quick Question once from one perspective and then return to answer again from your other role. (For example, a caregiver might choose to answer first for themselves and then return to answer from the perspective of the person diagnosed with FTD.)Have you (or your loved one) ever had contact with the criminal justice system because of behaviors or symptoms related to FTD? (For example: being accused of a crime, being detained, or being arrested.)YesNoNo, but there has been a "close call," or a crime was committed without law enforcement involvementNot sureWere you (or your loved one) taken into custody or arrested? YesNoHow concerned are you that a legal issue or contact with law enforcement might happen in the future?Not at all concernedSomewhat concernedVery concernedPlease 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
