Survey - ASiO - January Awareness Month 2021

ASiO - January Awareness Month 2021

We would love to hear some of your thoughts and feelings that you have had while watching Alicia’s Story. Alicia’s Story helps shed some light on the experiences the other 1.1 million Canadians who are affected by Alzheimer’s disease and dementia.

Please feel free to answer the questions below, or share your own thoughts, about this short film series.

Please provide your name and contact information below.


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	City: Required
*	Postal / ZIP Code: Required
*	Phone Number: Required

Question - Not Required - How did Alicia's Story make you feel? What feelings or memories did it evoke?

Question - Not Required - What have you learned from Alicia's Story?

Question - Not Required - Do you have any other comments/reflections?

Share your story with us:

Question - Not Required - How have you been impacted by Alzheimer's disease and dementia?

Question - Not Required - What has your experience been like?

Question - Not Required - What advice do you have for people who are going through similar situations?

You are giving the Alzheimer Societies in Ontario permission to use your Story.

Note: You must be 18 years old or older to submit a story. Your name and story may be published for others to read, however your personal information will not be shared or sold to third parties. Privacy Policy