Parkinson’s Questionnaire

Update on COVID-19

To: Our Sponsors, CROs, Patients, and Employees

At CenExel Clinical Research, our top priorities are the safety and health of our patients and employees. For our Centers of Excellence to provide the highest quality of clinical research, we established and maintain a COVID-19 Task Force with representatives from every Center. The Task Force is charged with continuous monitoring of the pandemic and providing guidance and communication.

Our clinical operations continue, and we have implemented the following additional safety measures:

Enhanced screening of everyone entering any of our facilities before they are admitted into our offices or clinical areas
Reinforced internal communication regarding the COVID-19 situation, CDC and SHRM recommendations, digital team meetings, and the importance of using sick leave for anyone who has signs, symptoms, or recent exposure to someone with suspected or diagnosed COVID-19
Additional cleaning and disinfecting materials provided through our clinic and office areas
Cross-training and preparations for contingency plans if key staff need to stay home

We will continue to monitor the current situation, coordinate with the proper authorities, and update our policies and procedures as needed to ensure the safety of our patients and employees.

Parkinson’s Questionnaire

Parkinson’s Disease Questionnaire

Your Name(Required)

First Last

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Birth Date(Required)

Sex(Required)

Height (feet/inches)(Required)

Weight (pounds)(Required)

Parkinson’s Disease History

Have you been diagnosed with PD?(Required)

When did you first start to notice symptoms of concern?(Required)

When were you diagnosed by a doctor?(Required)

What are your current symptoms?(Required)

Have you been genetically tested for PD?(Required)

When were you tested?(Required)

Were any mutations found?(Required)

GBA

LRKK2

None

Are you taking medications for your Parkinson’s?(Required)

If yes, what medications are you taking and when did you start them?(Required)

Do you have motor fluctuations where you can feel your medication kicking in or wearing off?(Required)

How long is your Off Time in hours?(Required)

Medical History

Have you had trouble with your memory or thinking?

Have you been officially diagnosed with mild cognitive impairment or dementia?

Have you felt lightheaded, faint, or dizzy when you stand up from a seated or lying position?

Have you had any issues with your speech such as softness or slurring?

Have you had any issues with excessive saliva or drooling?

Have you had any issues with swallowing, such as coughing or choking on solids and/or liquids?

Do you have any other medical conditions or significant medical history (i.e. heart attack/cardiovascular disease, stroke, brain surgery, DBS, kidney/liver disfunction, GI or urinary issues, diabetes, surgeries, etc.)?

Have you ever had a brain MRI?

When was this completed?

Would you be willing to get one?

Have you ever had a DAT scan?

When was this completed?

Would you be willing to get one?

Drug History

Do you use any currently marijuana or THC containing products (including CBD products)?

Do you currently drink alcohol?

If yes, how many drinks do you average per day?

Do you take any medications, either prescription or over the counter?

Have you been in any previous research trials?(Required)

Are you currently participating in any research trials?(Required)

​Update on COVID-19

To: Our Sponsors, CROs, Patients, and Employees

Parkinson’s Questionnaire

Parkinson’s Disease Questionnaire

Parkinson’s Disease History

Medical History

Drug History

Update on COVID-19