Welcome to one of the few available online sources providing an initial screening for memory or overall cognitive functioning. Dr. Steinberg, an expert on Alzheimer’s Disease and other Dementias, will use the responses to this short, but effective, questionnaire to assess for the presence of common indicators related to Alzheimer’s Disease or other types of Dementia. Consider this an important step that will greatly benefit you and your loved one.

The questionnaire will take approximately 15 minutes of your loved one's time. It is best for your loved one to be in a quiet room with little or no chance of interruption while completing the questionnaire. It is important to be honest. Being completely truthful offers maximum benefit.

Once the questionnaire is complete, you, as the facilitator, should review the questions and indicate in the space provided 1) if your loved one was correct or incorrect in his or her response, and 2) provide additional information when available or requested. This is a very important role and helps to ensure the accuracy of Dr. Steinberg's evaluation.

This questionnaire may be administered in one of two ways:

A) If your loved one is familiar with using a computer:
1) he or she may enter the responses directly online;
2) you, as the facilitator, should review selected responses for accuracy;
3) follow the instructions to submit the completed questionnaire to Dr. Steinberg;
4) fax the completed Acknowledgement to Dr. Steinberg at 856-782-1944; and
5) pay online for a written report from Dr. Steinberg.

B) For those individuals not familiar with using a computer:
1) the questionnaire may be printed and your loved one may fill in the answers
    on this print out with a pencil or pen;
2) you, as the facilitator, should review selected responses for accuracy;
3) the answers will then need to be entered manually online on the Evaluation
    page by clicking on "Click for Evaluation";
4) follow the instructions to submit the completed questionnaire to Dr. Steinberg;
5) fax the completed Acknowledgement to Dr. Steinberg at 856-782-1944; and
6) pay online for a written report from Dr. Steinberg.

The Acknowledgement can be accessed by clicking on the "Acknowledgement"
button below. Please click on the "print" button on the bottom of the Acknowledgement to print out a copy of the form.

Once the information is in its final form online, press the "Submit" button to be directed to the Payment page.

This assessment costs $19.95, payable with Visa or Mastercard over a secure server.

When the online payment is complete, all of the answers will be submitted to Dr. Steinberg.

After responses are submitted and Dr. Steinberg has received the faxed Acknowledgement, he will then review all of the information and provide you with a report that offers meaningful and practical information regarding your loved one's memory and cognitive functioning.



Contact Roy Steinberg, click the button below.

    If you would like more information
    to email Dr. Steinberg.

    Caregiving For Caregivers
    Roy Steinberg Ph.D.
    Tel  609.458.2540

In a moving and easy to read format, Dr. Steinberg has laid out a true caregiver's guide to dealing with Alzheimer's disease, from the first signs to the final stages.