If you have problems sending the request:
call our telephone number +39 340 4996980 or send us a message on Whatsapp
from Monday to Friday – 8.30am – 6.30pm

Registration - step 1

Personal Detail - step 2

Indicate your educational qualification: *
Which hand you use to write *

Pillar 1 — Medicine - step 3

These questions are about the beginning of the condition, before the diagnosis

Side of the body in which the first symptom started *

Pillar 2 - Exercise and Physical Activity - step 4

Have you even done physiotherapy / adapted physical activity for Parkinson?
In general how often in a week do you walk at least 30'? *
In general how often in a week do you do physical activity or exercise? (Thai Chi, dancing, Trekking, Nordicwalking, cycling...)
In general how often in a week you are physically tired, exhausted, fatigued?

Pillar 3 - Lifestyle - step 5

Food Diary…

Is it more difficult for you to eat solid or liquid food? *
Do you ever cough when you drink? *
Have you noticed a slowdown in eating during meals? *

UPDRS Scale - step 6

UPRDS rating scale: below indicate the level and frequency of criticality of each field

SLEEP PROBLEMS *

0 Normal; 1 Slight; 2 Mild; 3 Moderate; 4 Severe

DAYTIME SLEEPINESS *
PAIN AND OTHER SENSATIONS *
URINARY PROBLEMS *
CONSTIPATION PROBLEMS *
LIGHT HEADEDNESS ON STANDING *
FATIGUE *
SPEECH *
SALIVA AND DROOLING *
CHEWING AND SWALLOWING *
EATING TASKS *
DRESSING *
HYGIENE *
HANDWRITING *
DOING HOBBIES AND OTHER ACTIVITIES *
TURNING IN BED *
TREMOR *
GETTING OUT OF BED, A CAR, OR A DEEP CHAIR *
WALKING AND BALANCE *
FREEZING *

This completes the questionnaire… Thank you…