subject_line
*
Required Field
What information on Parkinson’s disease (PD) are you most interested in receiving? (Please check
the top 5
that apply)
*
Medication management
Driving
New medications available
Sexual function and intimacy
Surgical options
Sleep issues
Nutrition
Progression of PD
Speech and/or swallowing
Cognitive changes
Exercise
Depression
Stem cell therapy
Blood pressure and PD
Genetics
Care partner challenges
PD’s effects on people of varying ethnicities
Balance and freezing of gait
Environmental causes
Pain and PD
Emotional support
Estate planning/Elder attorney
Management of symptoms
Research
Fall prevention
Other:
Other:
How do you prefer to receive information about Parkinson's disease? (Please check
the top 3
that apply)
*
In-person support group
Helpline (toll-free number)
In-person education class/conference
Webinar/Virtual program with PD experts
Virtual/Online support group
Printed educational materials
Local healthcare professional
Online educational materials
Website
Other:
Other:
Please suggest new topics or programs you would find helpful:
*
Have you heard of the following APDA programs, services, or resources? (Please check
the top 5
that apply)
*
Local APDA Chapter or Information & Referral Center
APDA Symptom Tracker mobile app
Online information (including the APDA Resource page and APDA latest news and research)
APDA Optimism Walk
Webinars/Virtual programs (i.e., Dr. Gilbert Hosts, Let's Keep Moving with APDA, Unlocking Strength Within, Thriving Through OT)
APDA YouTube channel with past programs
“Ask the Doctor” Email Q&A
In-person education class/conferences (e.g., singing, dancing, exercise programs)
Printed educational materials
APDA A Closer Look blog
Fundraising/Social events
Weekly APDA information email
In-person/Virtual support groups
ParkinSex
Helpline (toll-free number)
Not applicable
iTunes podcasts
Other:
Other:
Have you utilized the following APDA programs, services, or resources? (Please check
the top 5
that apply)
*
Local APDA Chapter or Information & Referral Center
APDA Symptom Tracker mobile app
Online information (including the APDA Resource page and APDA latest news and research)
APDA Optimism Walk
Webinars/Virtual programs (i.e., Dr. Gilbert Hosts, Let's Keep Moving with APDA, Unlocking Strength Within, Thriving Through OT)
APDA YouTube channel with past programs
“Ask the Doctor” Email Q&A
In-person education class/conferences (e.g., singing, dancing, exercise programs)
Printed educational materials
APDA A Closer Look blog
Fundraising/Social events
Weekly APDA information email
In-person/Virtual support groups
ParkinSex
Helpline (toll-free number)
Not applicable
iTunes podcasts
Other:
Other:
Which of the following types of assistance have you found helpful or would be helpful to you in coping with Parkinson's? (Please check
the top 5
that apply)
*
Local APDA Chapter or Information & Referral Center
APDA Symptom Tracker mobile app
Online information (including the APDA Resource page and APDA latest news and research)
APDA Optimism Walk
Webinars/Virtual programs (i.e., Dr. Gilbert Hosts, Let's Keep Moving with APDA, Unlocking Strength Within, Thriving Through OT)
APDA YouTube channel with past programs
“Ask the Doctor” Email Q&A
In-person education class/conferences (e.g., singing, dancing, exercise programs)
Printed educational materials
APDA A Closer Look blog
Fundraising/Social events
Weekly APDA information email
In-person/Virtual support groups
ParkinSex
Helpline (toll-free number)
Not applicable
iTunes podcasts
Other:
Other:
How did you first become aware of APDA? (Please choose
one
)
*
Printed educational materials
APDA events
Public service announcement/Commercial
Postal mailings
Email communications
APDA website
Healthcare professional/Doctor referral
APDA support group
APDA Chapter
APDA donation
APDA Information & Referral Center
Local community support group
Other:
Other:
Do you feel you have adequate information on Parkinson’s disease?
*
Yes, I have enough information
No, I need more information
Please describe the type of additional information you need:
*
+
-
How likely are you to continue utilizing virtual/online programs?
*
Very likely
Somewhat likely
Not likely
I don't know
Do you prefer:
*
In-person programs
Virtual/Online programs
Combination of both
Do you/the person with Parkinson's currently see a Movement Disorder Specialist?
*
Yes
I have or the person with Parkinson’s has previously seen a Movement Disorder Specialist, but do not currently.
I do not or the person with Parkinson’s does not currently see a Movement Disorder Specialist, but plan to see one in the future.
No
Not applicable
How would you describe your current situation with the doctor? (Please select
all
that apply)
*
The doctor is a general neurologist.
The doctor is a general practitioner.
There are often questions not answered by the doctor.
Most of our questions are answered by the doctor.
Not applicable
How did you hear about this survey?
*
APDA website
APDA newsletter
APDA Chapter or Information & Referral Center
APDA email
Support group
Medical professional
Social media
Flyer/Brochure/Invitation
Friend/Family member
Other:
Other:
Would you like to receive the latest PD news, updates, and invitations from APDA via email? (If
yes
, please complete the information below)
*
Yes
No
Other method (e.g., mail)
Other method (e.g., mail)
First Name
*
Last Name
*
Mailing Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone
*
Email
*
We would like to learn more about our audience. The remaining questions are optional.
Please tell us about yourself. I am a: (Please choose which best describes you)
Person with Parkinson’s disease
Spouse/Significant other
Care Partner (not spouse or significant other)
Family member/Friend
Healthcare professional/Researcher
Other:
Other:
What is your year of diagnosis?
What is your month and year of birth?
What is the year of diagnosis for the person with Parkinson's disease?
What racial group(s) best describes you? (Please select
all
that apply)
*
White/Caucasian
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian or other Pacific Islander
Prefer not to answer
Other:
Other:
Are you Hispanic, Latino, or Spanish?
Yes
No
Prefer not to answer
Are you a Veteran?
Yes
No
Which most closely describes your gender (check
all
that apply)?
*
Woman
Man
Transgender woman
Transgender man
Non-binary
Agender/I don’t identify with any gender
Prefer not to answer
Other:
Other:
As we look to develop resources and programs in other languages, please indicate your preference below.
*
English preferred
Other language preferred:
Other language preferred: