Use these forms to collect information before the patient's visit. Patients and informants (family members, friends, or others who know the patient well) complete separate questionnaires that help clinicians identify cognitive and functional changes before the clinical evaluation.
Full cognitive assessment
Use this clinician form to document the comprehensive cognitive evaluation during the patient visit.
Download Full Cognitive Assessment Form (PDF)
Pre-visit questionnaires
Download pre-visit questionnaires for patients and informants. Whenever possible, send them before the appointment so clinicians can review responses in advance. Clinic staff may also administer or assist with completing the forms during the intake process.
In ACCT-AD, an informant is someone who knows the patient well—such as a family member, close friend, or caregiver—and can describe changes they have observed over time. Learn more about the role of an informant in the Approach to Assessment section.
| Language | Patient questionnaire | Informant questionnaire |
|---|---|---|
| English | Download patient questionnaire (PDF) | Download informant questionnaire (PDF) |
| Spanish (Español) | Download patient questionnaire (PDF) | Download informant questionnaire (PDF) |
| Chinese (Simplified / 简体中文) | Download patient questionnaire (PDF) | Download informant questionnaire (PDF) |
| Chinese (Traditional / 繁體中文) | Download patient questionnaire (PDF) | Download informant questionnaire (PDF) |
| Vietnamese (Tiếng Việt) | Download patient questionnaire (PDF) | Download informant questionnaire (PDF) |