New PD patient contact form

Full Name

Email address

Country

Adress

How many years have you had Parkinson's symptoms?

On which side of the body did your symptoms start?

What were your first symptoms?

On which side of the body are your symptoms currently dominant (stronger)?

What are your current symptoms (e.g. Tremor, Muscle stiffness, Movement slowing, Dystonia after taking L-Dopa, Dystonia in OFF, Pain, Dyskinesia, Difficulty walking, Freezing, Falls, Difficulty speaking, Constipation, Urinary problems...)?

How many hours a day do you shake/what percentage of the day do you shake?

How many hours spent having dyskinesias?

How many hours do you spend feeling "blocked"?

Have you tried taking L-DOPA?

If so, up to what dose? (L-Dopa equivalents)

Any side effects of L-DOPA :

What percentage of effectiveness does L-DOPA have on your symptoms?

Are you taking any other anti-Parkinson drugs?

Which ones and with which side effects?

What are your expectations of a MRgFUS intervention?

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