Pacific Research Network, Inc.

MEMORY CLINIC SERVICES

I am interested in the following information/services:

• Schedule a no-cost Memory Assessment

  I would like a no-cost memory assessment on:   Mon Tue Wed Thu Fri

  The best time for me is between:   8:30am - 12:30pm 1:00pm - 4:30pm

  I prefer the clinic in:   San Diego Rancho Bernardo

  Mr. Ms. Mrs. Dr.
  

  First Name:		MI:
  Last Name:
  Address:
  City:
  State:	Zip:

  
  Date of Birth: Month123456789101112 - Day12345678910111213141516171819202122232425262728293031 - Year19121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994
  
  

  Home Phone:
  Work Phone:
  Cell Phone:
  Other Phone:
  Email:

  
  

  I prefer to be contacted by: Home Phone Work Phone Cell Phone E-mail Other

  How were you directed to this website?
  

  Union Tribune North County Times The Reader Craigslist

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  I authorize Pacific Research Network to store my personal information in their confidential database.
  Yes No, I do not want my information stored

  Please enter the second letter of the English Alphabet. This is used for authentication purposes.
  

• Brochure
  Mr. Ms. Mrs. Dr.
  

  First Name:		MI:
  Last Name:
  Address:
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  	Communication: Best ways to interact with a person with dementia
  	Talking Points: Tips that can help Alzheimer's patients and loved ones communicate
  	Prevent Wandering
  	Successful Caregiving
  	English Spanish
  	African Americans and Alzheimer's Disease: The Silent Epidemic

  How were you directed to this website?
  

  Union Tribune North County Times The Reader Craigslist

  Google Sign on SanDiego.com Other

  I authorize Pacific Research Network to store my personal information in their confidential database.
  Yes No, I do not want my information stored

  Please enter the second letter of the English Alphabet. This is used for authentication purposes.
  

• Join Newsletter Mailing List

  Mr. Ms. Mrs. Dr.
  

  First Name:		MI:
  Last Name:
  Address:
  City:
  State:	Zip:

  
  

  How were you directed to this website?
  

  Union Tribune North County Times The Reader Craigslist

  Google Sign on SanDiego.com Other

  I authorize Pacific Research Network to store my personal information in their confidential database.
  Yes No, I do not want my information stored

  Please enter the second letter of the English Alphabet. This is used for authentication purposes.
  

• Schedule a Group Discussion

  I would like a representative of The Memory Clinic to deliver a presentation on Memory Loss and related issues to my group. Please contact me to discuss the details.

  Mr. Ms. Mrs. Dr.
  

  First Name:		MI:
  Last Name:
  Organization:
  Estimated # of Attendees
  Address:
  City:
  State:	Zip:

  
  

  How were you directed to this website?
  

  Union Tribune North County Times The Reader Craigslist

  Google Sign on SanDiego.com Other

  I authorize Pacific Research Network to store my personal information in their confidential database.
  Yes No, I do not want my information stored

  Please enter the second letter of the English Alphabet. This is used for authentication purposes.
  

• Attend an Open-House/Seminar at The Memory Clinic
  • Join an interest list for the next Open House

    Mr. Ms. Mrs. Dr.
    

    First Name:		MI:
    Last Name:
    Address:
    City:
    State:	Zip:

    
    

    How were you directed to this website?
    

    Union Tribune North County Times The Reader Craigslist

    Google Sign on SanDiego.com Other

    I authorize Pacific Research Network to store my personal information in their confidential database.
    Yes No, I do not want my information stored

    Please enter the second letter of the English Alphabet. This is used for authentication purposes.
    

  Sign up for a free subscription to "Care Advantage", a publication of the Alzheimer's Foundation of America
  In an emergency, the right information can make all the difference...please take a look at MedFob and their computerized medical records storage device

THE MEMORY CLINIC:

Memory loss associated with aging has become the most critical and potentially costly health care issue on the medical horizon. Sometimes simple forgetfulness develops into a more serious cause for concern which threatens to rob people of their memories and quality regarding independent living. The Federal government has focused more resources and research in an effort to avert a crisis. Pacific Research Network is an independent research center that is working with both the private and government sectors.

Pacific Research is committed to continue the work in memory loss that began 15 years ago. Pacific Research was a part of the effort to bring the FDA approved medication for memory loss to market, in addition to the four subsequent medications. However, our job is far from complete. We are currently researching medications that may stop memory declines and prevent Alzheimer's disease. We welcome inquiry into our programs and approaches which are cost-free and grant supported for those (or their family or friends), who are either concerned or are struggling with developing problems.

A HISTORY OF EXCELLENCE:

Over the past 30 years Pacific Research Network has made many contributions in the development of new medications to improve memory. Thousands of patients have been a part of our Memory Clinic's approximate 300 grant-supported programs in various types of memory-loss of the mildest to the most severe. Additionally, over 5,000 people have chosen to take advantage of The Clinic's unique 45-minute memory assessment. Many have chosen to participate in a study that might protect memory function. Some of those who took the memory assessment chose to take the results to their own physician for review or treatment. In addition, many have allowed us to store their results at the clinic for a future memory assessment comparison. These results comprise our "data-banking" that allows for a "critical assessment of changes over time," which allows for a detailedcomparison that may identify insidious changes that might go undetected.