DBS Candidate Assessment

1

Since how many years have you been suffering from Parkinson's disease?

1–3 years

3–5 years

More than 5 years

2

Do you get improvement with Levodopa?

Yes

No

3

Are you suffering from severe dyskinesia, severe rigidity, stiffness, or disabling motor symptoms?

Yes

No

4

Name* This field is required.

First Name

Last Name

5

Phone Number* This field is required.

Please enter a valid phone number.

6

Email

example@example.com

7

Assessment result