Quick Question: Tester Page Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Are you a current or former caregiver for someone with an FTD disorder? *Select OneYesNoWho are you a caregiver for?Select OneParentSpouseSiblingChildGrandparentOther...Caregiver for Other - Please specifyHow many hours per day do you/did you provide caregiver support to an FTD loved one?1-5 hours6-10 hours11-15 hours16-20 hours>20 hoursWhat is your current age?Select One18-25 years old26-30 years old31-40 years old41-50 years old51-60 years old61-70 years old71-80 years old> 80 years oldPlease Identify yourself: Select OneA 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
