Request to use the PRO-PD
The PRO-PD is free to use. In order to meet the needs of the users, we need to know who is using the scale and for what purposes. Permission to use the PRO-PD is granted upon completion of this form.
Name
First Name
Last Name
Email
example@example.com
Who are you? (check all that apply)
Person with Parkinsonism
Clinical care/ Health care provider
Research
Industry
Healthcare Administration
Insurance Company
Other
Company/ University Name, if applicable:
Name of the study/ project, if applicable:
Estimated number of PRO-PD users:
Estimated number of times each person will be asked to complete the PRO-PD:
Estimated date of study completion, if applicable:
Thank you for completing this form.
Permission to use the PRO-PD is granted upon submission of this form.
Submit
Should be Empty: