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.)Was the person with FTD ever referred to palliative care throughout their illness?YesNoWho referred them to palliative care?Primary Care PhysicianNurse PractitionerNeurologistHospital Care TeamFacility StaffSelf- Advocated for CareOtherReferred - OtherAt what stage of the diagnosis was referral to Palliative care made? At or near the time of DiagnosisMid Stage of FTD- worsening behavior changes, advancing language impairment, growing loss of judgment, and increasing need for supervisionEnd Stage of FTD- profound physical, cognitive, and functional decline, with individuals becoming completely dependent on others for all aspects of carePlease 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 myselfAn individual who carries a genetic variant associated with FTD but is not currently experiencing symptomsA non-biological family member of an FTD-diagnosed personOther...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
