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Parkinson's UK non-motor symptoms questionnaire

Have you experienced any of the following in the last month?
All the information you supply through this form will be treated with confidence and will only be used for the purpose for which it has been collected. Information supplied will be used for monitoring purposes. Your personal data will be processed and held in accordance with the Data Protection Act 1998. Developed and validated by the International PD Non Motor Group.

Non-movement problems in Parkinson’s
The movement symptoms of Parkinson’s are well known. However, other problems can sometimes occur as part of the condition or its treatment. It is important that the doctor knows about these, particularly if they are troublesome for you.
A range of problems is listed below. Please tick the box ‘Yes’ if you have experienced it during the past month. The doctor or nurse may ask you some questions to help decide. If you have not experienced the problem in the past month tick the ‘No’ box. You should answer ‘No’ even if you have had the problem in the past but not in the past month.

Question Title

* 1. Your number (given in clinic)

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* 2. Gender

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* 3. Date of birth

Date
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