PDQ-39 Questionnaire Name* First Last Email* Phone*Who is your Coach?*Who is your coach?Alan WeinbergAmy CallahanAmy WibholmChristina DinhCourtney RaglandDanica EdelbrockHope NicholsJason TenoJeff SeckendorfJudy MakMarty AcevedoMickey BurkeHiddenYour Coach's Email PDQ-39 QuestionnaireDue to having Parkinson’s disease, how often during the last month have you....1. Had difficulty doing the leisure activities which you would like to do?* Never Occasionally Sometimes Often Never or cannot do at all 2. Had difficulty looking after your home, e.g. DIY, housework, cooking?* Never Occasionally Sometimes Often Never or cannot do at all 3. Had difficulty carrying bags of shopping?* Never Occasionally Sometimes Often Never or cannot do at all 4. Had problems walking half a mile?* Never Occasionally Sometimes Often Never or cannot do at all 5. Had problems walking 100 yards?* Never Occasionally Sometimes Often Never or cannot do at all 6. Had problems getting around the house as easily as you would like?* Never Occasionally Sometimes Often Never or cannot do at all 7. Had difficulty getting around in public?* Never Occasionally Sometimes Often Never or cannot do at all 8. Needed someone else to accompany you when you went out?* Never Occasionally Sometimes Often Never or cannot do at all 9. Felt frightened or worried about falling over in public?* Never Occasionally Sometimes Often Never or cannot do at all 10. Been confined to the house more than you would like?* Never Occasionally Sometimes Often Never or cannot do at all 11. Had difficulty washing yourself?* Never Occasionally Sometimes Often Never or cannot do at all 12. Had difficulty dressing yourself?* Never Occasionally Sometimes Often Never or cannot do at all 13. Had problems doing up your shoe laces?* Never Occasionally Sometimes Often Never or cannot do at all 14. Had problems writing clearly?* Never Occasionally Sometimes Often Never or cannot do at all 15. Had difficulty cutting up your food?* Never Occasionally Sometimes Often Never or cannot do at all 16. Had difficulty holding a drink without spilling it?* Never Occasionally Sometimes Often Never or cannot do at all 17. Felt depressed?* Never Occasionally Sometimes Often Never or cannot do at all 18. Felt isolated and lonely?* Never Occasionally Sometimes Often Never or cannot do at all 19. Felt weepy or tearful?* Never Occasionally Sometimes Often Never or cannot do at all 20. Felt angry or bitter?* Never Occasionally Sometimes Often Never or cannot do at all 21. Felt anxious?* Never Occasionally Sometimes Often Never or cannot do at all 22. Felt worried about your future?* Never Occasionally Sometimes Often Never or cannot do at all 23. Felt you had to conceal your Parkinson's from people?* Never Occasionally Sometimes Often Never or cannot do at all 24. Avoided situations which involve eating or drinking in public?* Never Occasionally Sometimes Often Never or cannot do at all 25. Felt embarrassed in public due to having Parkinson's disease?* Never Occasionally Sometimes Often Never or cannot do at all 26. Felt worried by other people's reaction to you?* Never Occasionally Sometimes Often Never or cannot do at all 27. Had problems with your close personal relationships?* Never Occasionally Sometimes Often Never or cannot do at all 28. Lacked support in the ways you need from your spouse or partner?* Never Occasionally Sometimes Often Never or cannot do at all I do not have a spouse or partner 29. Lacked support in the ways you need from your family or close friends?* Never Occasionally Sometimes Often Never or cannot do at all 30. Unexpectedly fallen asleep during the day?* Never Occasionally Sometimes Often Never or cannot do at all 31. Had problems with your concentration, e.g. when reading or watching TV?* Never Occasionally Sometimes Often Never or cannot do at all 32. Felt your memory was bad?* Never Occasionally Sometimes Often Never or cannot do at all 33. Had distressing dreams or hallucinations?* Never Occasionally Sometimes Often Never or cannot do at all 34. Had difficulty with your speech?* Never Occasionally Sometimes Often Never or cannot do at all 35. Felt unable to communicate with people properly?* Never Occasionally Sometimes Often Never or cannot do at all 36. Felt ignored by people?* Never Occasionally Sometimes Often Never or cannot do at all 37. Had painful muscle cramps or spasms?* Never Occasionally Sometimes Often Never or cannot do at all 38. Had aches and pains in your joints or body?* Never Occasionally Sometimes Often Never or cannot do at all 39. Felt unpleasantly hot or cold?* Never Occasionally Sometimes Often Never or cannot do at all Submission Date* MM slash DD slash YYYY CAPTCHA Δ