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The following optional information will help us to serve you better. If you prefer to skip this section, please scroll to the bottom and click “Submit.” Thank you.
Diagnosed with FTD
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Do you have children under 18 living at home?
What is your diagnosis?
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For more details contact AFTD’s Helpline by phone or email.
Healthcare Professional Information
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If you are not affiliated with another organization, please enter Private Practictioner.
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Which of the below best describes your role as a healthcare provider? (Chose all that apply)
What are your main interests or needs related to FTD?
Please tell us about yourself.
What is your gender?
Do you have children under 18 living at home?
What best describes your role as a caregiver or care partner?
What year did your loved one pass away?
Are you currently in a support group?
Would you like to be contacted by AFTD if other caregivers in your area are looking for support?
For more details contact AFTD's Helpline by phone or email.
Please tell us more about your experience with FTD.
What is your loved-one's diagnosis?
What is the name of the person diagnosed?
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Please enter a value less than or equal to 120.
Was your loved-one employed at the time of diagnosis?
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About Yourself

Diagnosed with FTD

Healthcare Professional Information

Please tell us about yourself.

Please tell us more about your experience with FTD.