Parkinsons Disease Questionnaire


Your Situation

Your Stage


Do you have carer?
Are you in care?


How confident are you in making decisions for yourself?
Any Symptoms?
Tremor Severity
Slowed Movement Severity
Rigid Muscles Severity
Impaired Posture/Balance Severity
Writing Changes Severity
Loss of Automatic Movements Severity
Speech Changes Severity
Other Severity


Have difficulty doing the leisure activities which you would like to do?
Feel isolated and lonely?
Feel weepy or tearful?
Feel angry or bitter?
Feel anxious?
Feel depressed?
Feel worried about your future?
Feel you had to conceal your Parkinson’s from people?
Avoided situations which involve eating or drinking in public?
Feel embarrassed in public due to having Parkinson’s disease?
Feel worried by other people’s reaction to you?
Have problems with your close personal relationships?
Lack support in the ways you need from your spouse or partner?
Lack support in the ways you need from your family or close friends?
Unexpectedly fallen asleep during the day?
Have problems with your concentration, e.g. when reading or watching TV?
Feel your memory was bad?
Have distressing dreams or hallucinations?
Have difficulty with your speech?
Feel unable to communicate with people properly?
Feel ignored by people?
Have painful muscle cramps or spasms?
Have aches and pains in your joints or body?
Feel unpleasantly hot or cold?
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