Johns Hopkins Memory Care Family Checklist

This checklist helps screen for needs that people living with memory loss or dementia and their family or informal caregivers may have.

Please fill out this checklist to help better understand what you or your loved one might need right now.

When you are done, you will get a report with personalized results, including tips, helpful information, and resources based on your answers.

In an emergency, call 911.

Who should complete this assessment?

A caregiver who knows the person well, such as a family member, friend, or neighbor. It can also be administered by a staff member or health professional.

How long will it take?

Approximately 15 minutes. Your progress is saved on this device so you can come back if you need a break.

A caregiver embracing an older parent at home

How did you hear about the Checklist?

Select all that apply.

Where should we send results?

Required. Add one or more email addresses.

I am a caregiver for this person

Show questions about support, stress, care skills, and planning.

Where does your loved one live?

Start typing a city, county, or ZIP.

Where are you located?

Used only to compare nearby support options.