TemPo Parkinson's Study - See if you are Eligible

1
Are you taking this questionnaire on behalf of yourself or someone else?* This field is required.We're asking this to better assist you throughout the questionnaire. Please note: If you are taking this on behalf of someone else, please answer all of the following questions as if you were the patient.
MyselfSomeone else
2
Please select your age group* This field is required.To participate in the TemPo Studies, you must be 40 to 80 years old.
Under 18
40 to 80
18 to 39
81 or older
3
Have you been diagnosed by a doctor or medical professional with Parkinson’s disease (PD)?* This field is required.This will help us to determine whether the TemPo Studies are a potential option for you to consider.
Yes
I don't know / Unsure
No
4
When did you receive your PD diagnosis?* This field is required.Your medical history will help us to determine which of the three TemPo Studies may be right for you.
Less than 3 years agoThree or more years ago
5
Which of the following best describes your current PD treatment:* This field is required.Your treatment history will help us to identify which TemPo Study may be right for you.
I have never taken a medication (levodopa or dopamine agonists) to help manage PD symptoms
I currently take levodopa or a dopamine agonist treatment to help manage PD symptoms
I have taken levodopa or dopamine agonists in the past to help manage PD symptoms, but it was not longer than 3 months and I no longer take them.
I don't know/Unsure
6
Have you previously undergone a surgical procedure for PD (e.g., deep brain stimulation)?* This field is required.This will help us to determine whether the TemPo Studies are a potential option for you to consider. Important: If you are planning to undergo a surgical procedure for PD within the next nine months, please select “Yes.”
Yes
I don't know / Unsure
No
7
How do you want to be contacted?* This field is required.By selecting either below you consent SC3 Research Group to process your information and contact you. We care about your privacy and will ONLY contact you regarding Essential Tremor and related studies.
EmailPhone
8
Your name* This field is required.
First Name
Last Name
9
What is your email address?* This field is required.We'll only contact you from neurosearch-usa.com (SC3 Research Group) to provide more information about ET studies.
example@example.com
10
Can we also grab your phone number?* This field is required.We'll only contact you from (626)2502070 to provide more information about Essential Tremor studies.
Please enter a valid phone number.
11
Do you have a preferred time?(Optional) Let us know when's the best time to contact you.
Should be Empty: