Neurology Visit Prep

www.parkinsonz.org

My Care Team: Other Care Team Members: Rank Your Top 3 Symptoms: Symptom 1: Symptom 2: Symptom 3: Parkinson's Medications: Other Medications: Supplements: Exercises: How many days per week do you exercise? My Goals for the Future:

Increase physical activity Increase social activity Attend support groups Volunteer to help others

My Top 3 Questions for My Doctor: 1. Most important question 2. Second question 3. Third question Additional notes or questions: I am most grateful for:

Thank you! Please print 2 copies — one for yourself and one for your doctor.

Thank you for your help. Please send any feedback—positive or negative—and any suggested revisions to Sara Whittingham, MD at parkinsonzexercise@gmail.com.

Please visit www.parkinsonz.org to connect with and be inspired by other Parkinsonz Warriors.