Sign Up to be a Community Memory Screening Site

Please complete this form to register to be a Community Memory Screenings site. Fields marked with * are required. Participating sites are responsible for selecting a qualified healthcare professional to conduct the screenings. AFA provides all the necessary tools—at no cost—to seamlessly and effectively carry out the memory screenings. These materials will be sent to you via email within three business days. We will review your registration and contact you with any concerns prior to posting.