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    MEDICAL DISCLAIMER

    This assessment is the result of years of practice experience and clinical research. The results, by necessity, are of a general nature and should not be viewed as a substitute for an evaluation or treatment by a competent medical specialist. Self-report assessments have advantages and limitations. This assessment is intended as an information and education tool for you and your loved ones, and is not designed to replace your health care provider’s professional judgment regarding your health. Always discuss any recommendations with your personal physician. The assessment is not intended to diagnose, treat, or cure any medical condition. Please work with your health care provider for advice about your specific medical condition(s) and treatment(s) for such condition(s).

    Hello!

    Thank you for taking the Brain Health Assessment.

    This should only take about 5 minutes and your answers are completely confidential.

    Tell Us About Yourself

    Are You: *

    How old are you? *

    I’m great at staying organized. *

    I find myself losing focus easily. *

    My attention span is quite short. *

    I’m usually patient enough to avoid line-cutting. *

    I often lose my train of thought mid-conversation. *

    I struggle to wait for things I want. *

    I find remembering things challenging.*

    My memory isn’t as sharp as it was a decade ago. *

    I often forget people’s names. *

    I work out more than twice a week. *

    I usually get 7-8 hours of sleep every night.*

    My eating habits are often inconsistent or unhealthy.*

    I drink more than two regular-sized cups of coffee daily.*

    I consume sugary soft drinks daily. *

    I have more than four standard alcoholic beverages a week.*

    I smoke or am often around secondhand smoke. *

    I spend over an hour a day watching TV. *

    I have difficulty falling asleep or staying asleep. *

    My work or home environment is very stressful. *

    I feel happy and fulfilled in my close relationships. *

    I regularly engage in activities that challenge my brain. *

    I tend to focus on problems more than positives. *

    I often find myself being argumentative or disagreeing with others. *

    My thoughts tend to repeat or get stuck on certain things. *

    I often feel down or sad. *

    I frequently worry about things. *

    I find it hard to let go of past hurts or grievances. *

    I often have negative thoughts. *

    My self-esteem is generally high. *

    I find it hard to feel joyful.

    I often misunderstand things or take them personally. *

    I find it difficult to relax. *

    I tend to expect the worst in situations. *

    I’m very sensitive to criticism. *

    I bite my nails or pick at my skin.*

    I frequently feel tense or anxious.*

    Most days, my energy levels are great.*

    I often deal with cravings. *


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