For new Parkinson's contestants who wish to participate in an apprenticeship and accompaniment project

If you are interested in being accompanied by a companion, fill out the questionnaire at the bottom of this page.

For more information, you can call the hotline 054-6125043

Thank you for your cooperation

Questionnaire for trainee

First step - private information

First name *

Last name *

Phone *

Email *

ID.

settlement

Marital status *

# of kids

Date of diagnosis of the disease

Date of birth

Past occupation

Preoccupation with the present

Step Two - How interested are you in expanding your knowledge on the following topics?
(Values: 5 very high 4 high 3 reasonable 2 medium 1 very low)

Parkinson's disease *

Parkinson's Association Activities in Israel *

Rights of chronic patients *

Self-management of the disease *

Support groups *

Orientation on the association's website *

Step Three - What are the daily challenges related to Parkinson's disease that you face?

You can choose several challenges*:

Additional challenges