Thank you for taking the time to complete this survey. Whether you reached out to us by phone or email, or were referred by a health care provider, we want to know if our services helped you to connect with the support you needed.

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* 1. As a caregiver of a person with mild cognitive impairment (MCI), Alzheimer's disease or another dementia, I regularly feel (choose all that apply):

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* 2. As a person with mild cognitive impairment (MCI), Alzheimer's disease or another dementia, I regularly feel (choose all that apply):

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* 3. Since being in touch with the Alzheimer Society, I feel I have (Choose all that apply):

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* 4. The information and support provided to me by the Alzheimer Society was practical and focused on my personal situation.

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* 5. The Alzheimer Society has made me aware of available supports and services and provided information about how to access these services.

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* 6. Through my contact with the Alzheimer Society, I have been able to develop care strategies for supporting myself and the person I'm caring for.

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* 7. Through my contact with the Alzheimer Society, I feel I am better able to cope with my situation.

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* 8. I find my interaction with the staff I talk to at the Alzheimer Society empathetic and respectful.

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* 9. I am satisfied with the information, education and/or supports I have received from the Alzheimer Society.

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* 10. I would recommend to others that they use the Alzheimer Society as a resource if they, or someone they know, are diagnosed with MCI, Alzheimer's disease or another dementia.

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* 11. Through contact with the Alzheimer Society, I am more informed about (Choose all that apply):

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* 12. As a result of my interaction with the Alzheimer Society of Manitoba, I have now taken the following steps towards future planning (check all that apply):

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* 13. Through my interaction with Alzheimer Society staff, I have used or received the following Alzheimer Society resources (Choose all that apply):

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* 14. Physicians and health/community care providers or other professionals can refer people with dementia and their care partners to the Alzheimer Society for information, support and education. I was:

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* 15. For those respondents who were referred: When asked by a physician or health/community care provider or other professional if I was interested in being referred to the Alzheimer Society of Manitoba, I felt (Choose all that apply):

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* 16. My first contact with the Alzheimer Society was:

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* 17. Over the last 2 years, I have been in contact (by telephone, email, in-office visit, etc.) with the Alzheimer Society:

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* 18. When I have talked to Alzheimer Society staff, I have felt (Choose all that apply):

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* 19. I am a:

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* 20. I am:

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* 21. I am:

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* 22. I live:

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* 23. I, or the person I am caring for, have been diagnosed with Mild Cognitive Impairment (MCI), Alzheimer's disease or another dementia:

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* 24. Where does the person with cognitive changes, MCI or Alzheimer's disease or another dementia currently live?

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* 25. Please include any additional feedback or comments you have regarding the Alzheimer Society's services:

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