Johns Hopkins Memory Care Family Checklist©

This checklist helps screen for different needs that people living with memory loss or dementia and their family or informal caregivers may have. Not all people experience the same needs or need the same kind of help.

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

When you are done, you'll get a report with personalized results. It will include tips, helpful information, and a list of resources based on your answers.

In an emergency, call 911.

Who should complete this assessment?

This checklist should be completed by a caregiver of the person living with dementia such as a family member, friend, or neighbor who knows the person well. It can also be administered to the caregiver by a staff member or health professional.

How long will it take?

It will take approximately 15 minutes to complete this assessment.

For privacy reasons, your personal information is not saved, so please complete the Checklist when you have 10-15 minutes to finish it. You won’t be able to save your progress.

Personalized results.

Your email address is required to get a copy of your personalized results, but will not be saved. Your results will not automatically save to your computer, but you will be able to manually save or print the report.

To help us personalize resource recommendations and identify local community supports, please tell us about the location of the person with memory loss or dementia.