The Alzheimer Flame of Hope, in cooperation with the pharmaceutical industry, has established a memory screening program for seniors. The testing will be done by appointment in major population centers throughout Canada and will consist of a series of questions and drawings with a trained evaluator, taking up to thirty minutes. The results and recommendations will be sent to your family physician with a copy to yourself.

There is no charge for the assessment as it is being done as a public service as funds become available through tax deductible donations.

As part of the screening process, each senior needs to be pre-screened by a friend or family member using a watch with a second hand. Ask the senior to name as many four-legged animals as possible in a sixty second period. To get an accurate score, the senior should not be prompted during the sixty second period. The number of animals named in a sixty second period should be recorded below. The medical team will evaluate the results.

Memory screening is recommended on a yearly basis for everyone who is over age 70 and who is not already taking a cholinesterase inhibitor.

I understand that the results of the screening as well as any recommendations will be supplied to me as well as to my family physician (walk in clinic) listed below.
I request that an appointment be made for me to have this assessment.

Please note, if you have trouble submitting the form, please click here to download & print the attached form and mail it to us . We are working on this issue & hope to have it cleared up shortly.