C-SARS Evaluation - CURESZ Foundation

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Before you begin(Required)

The C-SARS is a voluntary self-assessment to help you decide whether to talk with a qualified healthcare professional about cognitive concerns. It does not diagnose schizophrenia or any other condition, does not replace a professional valuation, and does not create a patient–provider relationship with CURESZ. It is intended for adults 18 and older.

We collect your answers to 12 questions, and calculate your scores, only to show you your results. We do not ask for your name or email address, and we do not store your IP address. When you finish, your results will appear on screen with a link to download them as a PDF. The link works for 20 minutes.

Please download or save your results right away. We do not email results, and your responses are deleted from our website within one day. We do not sell your information, use it for research, or use your answers for advertising or fundraising.

Please read our C-SARS Assessment Privacy Notice before you begin. If you prefer not to submit anything online, you may download the C-SARS Form PDF and complete it privately.

I have read this notice and the Assessment Privacy Notice, and I agree to CURESZ collecting and using my responses as described. (required)

1. I have difficulty staying focused on something I am reading or a TV program I am watching

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

2. I have difficulty remembering things that happened or what people told me

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

3. I forget what I am supposed to do

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

4. I forget where I put things

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

5. When I am speaking I forget what I was going to say

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

6. I have difficulty planning ahead or making decisions

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

7. I keep doing the same thing even though it does not work

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

8. I do things without thinking

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

9. I have difficulty adjusting to changes

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

10. I tend to be slow in mental or physical tasks

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

11. I have trouble reading someone's facial expression or gestures

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

12. I have difficulty understanding how another person feels

A. FREQUENCY(Required)

Rarely

Sometimes

Often

All the time

B. HOW MUCH IT INTERFERES WITH MY LIFE(Required)

Rarely

Sometimes

Often

All the time

Frequency Score

Severity Score

1. I have difficulty staying focused on something I am reading or a TV program I am watching

2. I have difficulty remembering things that happened or what people told me

3. I forget what I am supposed to do

4. I forget where I put things

5. When I am speaking I forget what I was going to say

6. I have difficulty planning ahead or making decisions

7. I keep doing the same thing even though it does not work

8. I do things without thinking

9. I have difficulty adjusting to changes

10. I tend to be slow in mental or physical tasks

11. I have trouble reading someone's facial expression or gestures

12. I have difficulty understanding how another person feels

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