PMI Survey Form
PMI is interested in learning what you have to say about improving memory fitness and preventing memory loss with age. All answers to any questions are kept confidential (see Privacy Policy) and will be used to improve our service to the community at large. Your voluntary participation is appreciated. Results to PMI surveys will be found on the memoryzine.com home page. Additional survey questions will be posted from time to time. Thank you for participating.
Privacy Policy
If you could improve just one everyday memory task, which task would that be?
Have you ever taken part in any online memory training such as offered by Memory University?
Are you aware of other factors, other than raw memory power -discribed in the Memory Monitor - which can affect your memory fitness?
Yes
No
Do you subscribe to any memory fitness newsletters?
Yes 
No
Have you ever purchased a self-help product (e.g., book, tape, course, etc.) for yourself?
Yes
No
Have you ever purchased anything online?
Yes 
No

Please tell us a little about yourself:

Gender?

Male
Female

Zip Code/Postal Code:

Age Range:

Under 18
19-29
30-39
40-49
50-59
60-69
70-79
80-89
90-99
100 or older

How did you learn about PMI?

A Friend
Personal Search
A Family Member
A Friend
A Physician
Other Health Provider
Insurance Company
Newspaper/Magazine
Radio
TV
National Institutes of Health
AARP
Senior Net
American Psychological Assoc.
Alzheimer's Association
Search Engine Information
Search Engine used to find us:
Search terms used to find us:
(Multiple items may be chosen).

Your current interest is:

Non-Professional
Professional

If a Non-Professional:

Personal
Caregiver

If a Professional:

Research
Academia
Clinical Practice/Service Provider
Please indicate your professional credential designation ( e.g., PhD, MD/OD, OT, SLP, etc.) 

Would you like to be notified of future memory-related surveys or newsletters?

Yes
No

Preferred E-mail Address:

Tell our researchers what you think or provide additional comments here:

Privacy Policy: PMI is a scientific research organization and subscribes to strict principles of privacy. PMI does not sell, distribute or publish any personal information provided to it. INDIVIDUAL SURVEY INFORMATION SUBMITTED IS CONSIDERED CONFIDENTIAL AND WILL NOT BE DIVULGED TO ANY THIRD PARTY. Only summary information, not associated with any individuals, will be published.



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Send your comments and questions to
 webmaster@memoryzine.com