Diagnosed Medical Conditions Question Title * 1. MURRAY HILL NATIONAL, A NATIONAL MARKET RESEARCH COMPANY HAS BEEN COMMISSIONED TO INTERVIEW PARTICIPANTS FOR AN UPCOMING PROJECT. THIS WILL BE A 60 MIN LONG TELEPHONE INTERVIEW. IF YOU ARE INTERESTED IN THE PAID (100.00) PLEASE ANSWER ALL OF THE QUESTIONS. THIS PANEL WILL BE USED FOR VARIOUS DIAGNOSES, SO PLEASE FILL OUT ALL OF THE QUESTIONS THAT APPLY TO YOU AND DISREGARD THOSE THAT DON'T Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. What is your age? Question Title * 3. Are you willing and able to participate in a telephone study which includes and interview lasting 60 to 90 minutes in duration? Yes No Question Title * 4. Are you willing to have the interview audio recorded? Yes No Question Title * 5. Can you read and speak English fluently? Yes No Question Title * 6. Are you willing and able to sign a document indicating that you understand the study's purpose and procedure? Yes No Question Title * 7. What is your gender? Female Male Question Title * 8. What is your ethnicity? African American Asian Hispanic Native American Pacific Islander Caucasian Mixed Other Question Title * 9. What is your current employment status? Full time Part time Unemployed Disabled Retired Student Question Title * 10. What is your highest level of completed education? Some high school High school grad Some college Associates Bachelors Masters Doctorate work or degree Question Title * 11. Are you or a loved one diagnosed with any of the following conditions? Self Loved one Alzheimer's Alzheimer's Self Alzheimer's Loved one Multiple Sclerosis Multiple Sclerosis Self Multiple Sclerosis Loved one Parkinson's Parkinson's Self Parkinson's Loved one Spina Bifida Spina Bifida Self Spina Bifida Loved one Spinal Muscular Atrophy Spinal Muscular Atrophy Self Spinal Muscular Atrophy Loved one Question Title * 12. Are you currently taking and responding to L-Dopa? Yes No Currently taking with no effect Question Title * 13. Are you able to recognize L-Dopa wearing off? Yes No Question Title * 14. How often are you taking medication ( L Dopa or dopamine agonist) a day? 1 2 3 4 5+ Question Title * 15. Do you experience off time of more than 2.5 hours per day on average? Yes No Next