Pre-Registration Form for Stories in the Moment Research Study

Pre-Registration Form for Stories in the Moment Research Study

Thank you for expressing an interest in the research study Stories in the Moment: dance program for people living with dementia!
The purpose of this research study is to better understand how the dance program, Stories in the Moment, supports the quality of life and wellbeing of people living with dementia and their care partners.

We invite you to fill out the following information if you are interested in joining the study.
- You will receive an email from one of our team members to schedule a telephone or videoconference (Zoom) call.
- During this call, the team member will help answer any questions you may have about the research study and review what you can expect if you decide to join.
- If you decide to join, the team member can help you register.
We will only use your email and telephone number to contact you regarding this research study. If you decide not to join this research study, any personal information you shared with us in this form (including your name or contact information) will be destroyed.

Questions? Contact Magda Kaczmarska at 520-331-5726 or magda.kaczmarska@gbhi.org.

This research study is being conducted by researchers sponsored by the Global Brain Health Institute, Alzheimer's Association and Alzheimer's Society UK and has been granted ethical approval by Pearl Institutional Review Board (IRB).
Name*

First NameLast Name
Email*

Confirmation EmailWe will email you at this address to schedule a telephone or videoconference (Zoom ) call.
Phone Number*

Area CodePhone Number
If you are filling out this form on behalf of another person, what is their full name? What is your relationship? (Optional)
For example: John Doe (father)
Please let us know if you have any questions for our research team at this time.
Should be Empty: