3. Have you been diagnosed with Parkinson's disease by a physician?

3. Has your loved one been diagnosed with Parkinson's disease by a physician?

4. Have you experienced any of the following symptoms for five years or longer?

Select all that apply:

4. Has your loved one experienced any of the following symptoms for five years or longer?

Select all that apply:

5. You may have better or worse control over your movements depending on the time of day. For each period of the day, indicate when you are typically "ON" (good control) or "OFF" (poor control).

5. Your loved one may have better or worse control over their movements depending on the time of day. For each period of the day, indicate when they are typically "ON" (good control) or "OFF" (poor control).

6. Are you currently treating your Parkinson's disease with any of the following drugs?

6. Is your loved one currently treating their Parkinson's disease with any of the following drugs?

7. Have you been on the same medication regime for a year or more?

7. Has your loved one been on the same medication regime for a year or more?

Which other approaches are you currently using to manage your symptoms

Which other approaches is your loved one currently using to manage their symptoms

8. Have you ever been diagnosed with any of the following conditions?

8. Does your loved one have any of the following conditions

9. Please fill out the form below if you would like us to contact you and keep you up to date on treatment options for Parkinson's.

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