November 2025 Memory Screening

Free Memory Screening Registration (November 12, 2025)

Screenings take place at the Community Health & Wellness Center (3162 County Rd B, Stoughton). Please complete the form and select a time slot below. If you have any questions, contact the Community Education Coordinator at kperna@stoughtonhealth.com or call 608-877-3498. Thank you!
Memory screenings for November are now full. To be put on the waitlist, please contact the Community Education Coordinator at kperna@stoughtonhealth.com or call 608-877-3498. Thank you!
Your Name*

First NameMiddle NameLast Name
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Screening Time
Additional Comments and Questions
Should be Empty:

Free Memory Screening Registration (November 12, 2025)