Resources Feedback Resource Feedback QuestionnaireStep 1 of 250%Would you like to remain anonymous while filling out this questionnaire?(Required) Yes NoIf you choose to share your name and contact information, you may be eligible to receive a gift card after your feedback has been verified.Name(Required) First Last Email(Required) Phone(Required)Resource Title(Required)The 4 Ms of Age-Friendly CareHealthy Heart, Healthy Brain10 Signs That Might Be DementiaHealthy Food, Healthy BrainReduce Your Risks of DementiaTribal Law & PolicyTribal Resolution ToolkitADRD State PlansDementia BingoHealthy Brain Rack CardsThe River Story VideoDementia 101 VideoSocial Media ToolkitWandering ToolkitQuestions to Ask Your Doctor About Memory LossSymptom TrackerMyths & Truths About Memory LossWhat state or tribal region are you in?(Required)What role(s) best describe you?(Required) Tribal Elder Family member or person who provides care for an individual with dementia Paid Caregiver/Professional Caregiver Concerned Person (Friend, Neighbor) Tribal Program Staff (e.g., Title VI, APS, CHR, Clinc) Healthcare of Social Service Professional Student or Educator Other (please describe)Select all that applyWhat role(s) best describe you – otherIf other, please describe hereHow have you used this resource?(Required) Shared it with staff or community members Used it in a presentation or training Integrated it into a program or policy Shared on social media or newsletter Planning to use it soon Haven’t used it yet Other (please describe)Select all that applyHow have you used this resource – otherIf other, please describe hereWhat changed after using this resource?(Required) Increased awareness or understanding Helped start conversations about brain health or dementia Improved confidence in serving Elders Supported staff or caregiver training Inspired new ideas or collaborations Other (please describe)Select all that applyWhat changed after using this resource – otherIf other, please describe herePlease use this space to provide other comments, feedback, stories, suggestions on how we can improve, elaborate on responses above, etc.EmailFacebookXLinkedIn
