JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Parkinson's During Covid Survey
I am writing a short story about the experiences of people with Parkinson's and their caregivers during the COVID-19 pandemic for my university. While I have personal experience from my mother, who was diagnosed a few years ago, I wanted to get a feel of the community's experiences. All answers and personal information will be confidential. For any questions or a copy of the final product, please email
nad140@students.jefferson.edu
.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Q1. Please choose the option(s) that best identify you.
*
I am diagnosed with Parkinson's Disease.
I am a loved one of someone with Parkinson's Disease.
I am a caregiver of someone with Parkinson's Disease.
I am a medical professional serving someone with Parkinson's Disease.
Other:
Required
Q2. How would you describe/compare your current Covid normal versus your pre-Covid normal? This may include but not limited to changing symptoms, management of symptoms, relationship with friends and family, or mental states.
Your answer
Q3. How does stress affect your symptoms?
Your answer
Q4. During the pandemic have you felt more stressed? If so, why?
Your answer
Q5. Are you vaccinated? Why or why not?
Your answer
Q6. Is there anything else you'd like us to know about you or your experiences with Parkinson's Disease?
Your answer
Q7. Would you like a copy of the short story once it is finished?
Yes, please email me.
No, I do not wish to be contacted.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report