Parkinson and Movement Disorder - Free Information Session

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Monday 13 May 2019, 1:30pm - 4:30pm

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Title *

Name *

Surname *

Email *

What is your movement disorder?

Parkinsons

Dystonia

Essential Tremor

Tourette's Syndrome

Carer

Other:

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If you have a movement disorder, who is your GP and what is their address?

This information will be used to invite GPs to a GP Information Session

Please list any dietary requirements:

Would you like to be informed of research and events? *

Yes

How did you find out about this event?

Support Group

Local GP

Email from Organiser

Other:

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Please note that a photographer will be present at this event, please advise your preference

Yes photos are fine

No photos of me thanks

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