Your Personal Profiler Start by completing your Personal Profiler to help us match you with the right program and verify coverage. 1: I have difficulty staying focused on something I am reading or a TV program I am watching How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 2: I have difficulty remembering things that happened or what people told me How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 3: I forget what I am supposed to do How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 4: I forget where I put things How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 5: When I am speaking I forget what I was going to say How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 6: I have difficulty planning ahead or making decisions How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 7: I keep doing the same thing even though it does not work How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 8: I do things without thinking How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 9: I have difficulty adjusting to changes How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 10: I tend to be slow in mental or physical tasks How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 11: I have trouble reading someone’s facial expression or gestures How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time 12: I have difficulty understanding how another person feels How often: Rarely Sometimes Often All the time How much does it interfere with my life: Rarely Sometimes Often All the time Submit
