subject_line
What information on Parkinson’s disease are you most interested in receiving? (Please check all that apply)
Medication management
Surgical options
Genetics
Environmental causes
Nutrition
Exercise
Physical and/or emotional support
Effects on different races
Speech and/or swallowing
Stem cell therapy
Other
Other
How would you prefer to receive information about Parkinson's disease? (Please check all that apply)
In-person support group
Online support group
Help line (toll-free number)
Printed materials
Local helping professional
Education class/symposium
Website
Webinar/virtual program
Other
Other
Have you heard of the following APDA programs, services, or resources? (Please check all that apply)
Support groups
“Ask the Doctor” Email Q&A
Education class
Fundraisers
Webinars/teleconferences
Virtual live classes
Help line (toll-free number)
Conferences
Exercise programs
Booklets
iTunes podcasts
Other
Other
Have you utilized the following APDA programs, services, or resources? (Please check all that apply)
Support groups
“Ask the Doctor” Email Q&A
Education class
Fundraisers
Webinars/teleconferences
Help line (toll-free number)
Conferences
Exercise programs
COVID-19 information
Dr. Gilbert Hosts
Keep Moving with APDA
Booklets
iTunes podcasts
Other
Other
Have you found the following type of assistance useful in helping you cope with Parkinson's? (Please check all that apply)
Group meetings with others
Group exercise with others
Local information
Guidance to local resources
Latest news and research
Printed educational materials
Online information
Virtual programs
Not applicable
Webinars/teleconferences
Other
Other
Have you found the following type of assistance useful in helping you cope with Parkinson’s during the COVID-19 pandemic? (Please check all that apply)
*
Virtual exercise
Dr. Gilbert Hosts
Patient assistance
Virtual support groups
Webinars
COVID-19 information on APDA's website
PD information on APDA's website
How did you first become aware of the APDA? (Please choose one)
Publications
Events
Postal mailings
Email communications
Website
Chapter
Support group
Public service announcement/commercial
Clinician referral
Other
Other
Do you feel you have adequate information on Parkinson’s disease?
Yes, I have enough information
No, I need more information
How likely are you to continue utilizing online virtual programs?
*
Very likely
Somewhat likely
Not likely
Don't know
Have you participated in a telehealth or telemedicine visit with your neurologist?
Yes
No
I am a: (Please choose one)
*
Person with Parkinson's disease
Family member
Friend
Nurse
Spouse
Care partner
Researcher
Physician
Other
Other
Number of years since diagnosis
1 month-3 years
4-5 years
6-10 years
11-19 years
20+ years
N/A
Have you served in the military?
Yes
No
Which branch(es) of the military did you serve? (Please check all that apply)
Air Force
Army
Coast Guard
Marines
National Guard
Navy
What is your race/ethnicity (Please choose only one)
*
American Indian or Alaskan Native
Asian/Pacific Islander
Black or African American
Native Hawaiian or Pacific Islander
Hispanic
White/Caucasian
Brown
Prefer not to answer
Would you like to receive APDA email updates and invitations? (If yes, please complete the information below)
Yes
No
First Name
Last Name
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
Email