Participant Details

Does the participant have access to a computer or tablet with internet connectivity? Or is someone able to provide this access for them?

Please note that HBH is an online study, with limited capacity for in-person assessments.

Note: Primary language refers to the language they will be able to complete an assessment in.

Has the participant ever been diagnosed with moderate to severe Dementia, such that an additional cognitive assessment would not be informative to their ongoing care and management?

This includes a diagnosis of: Alzheimer's disease, Vascular Dementia, Parkinson's disease, Dementia with Lewy bodies or another type of dementia.

If the participant has a diagnosis of Mild Cognitive Impairment (also referred to as "MCI"), please select no.

Is the participant currently experiencing symptoms of any of the following health conditions that require treatment? (select all that apply):

- Alcohol use disorder

- Substance use disorder

- Untreated mental health condition (e.g., Schizophrenia, bipolar disorder, major depressive disorder)

Contact Details

Does the participant currently reside in Australia?
Is the participant aware of this referral?
Is the participant able to be contacted directly regarding this referral?

Referral from Another Study

GP Details

Is the participant's GP aware of this referral?

Referrer Information