Parkinson's Well-Being Map™

STEP 1: With your mouse click on a category heading (e.g. sleep disturbances) to open up the list of symptoms in this category. Click on the symptom that you experience most. Then scroll down and press submit.

STEP 2: Once a symptom has been selected the Map will open to let you rate how frequently this symptom affects you, using the 0-4 scale, where 0 is never and 4 is always. Click on the most appropriate number with your mouse.

You can now move to the next category.


DATE:
  1. 0 = Never
  2. 1 = Occasionally
  3. 2 = Sometimes
  4. 3 = Often
  5. 4 = Always
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Please make your selection
Please make your selection
Please make your selection
Please make your selection
Please make your selection
Please make your selection
Please make your selection
Please make your selection
Now rate how much this affects you from 0 (never) to 4 (always)
Your Map is now completed

The aspect I want to focus on the most is:

Next
 
My next doctor visit:

The three most important questions to ask my care team are:

I am taking the following Parkinson's medications:


Other Medications including OTC and Dietary Supplements:


To save this map to my computer, click on "Save as PDF"
Next update of my Map:


THANK YOU!
Your Well-Being Map™ will be generated soon. Please wait for the download to begin.


If your download doesn't start automatically, please click here:

© UCB 2013. All rights reserved. NP328-0812B