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>Email 3
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>SECTION B:                             PARKINSON BASICS
>
>TO ANSWER SECTION B:   WRITE IT.       CHECK IT.
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>Age at Diagnosis: _______
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>Year of Diagnosis: ________
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>
>CHOOSE ONE:
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>Number of years with:  PD ______
>                               PD+ ______
>                               Incomplete Diagnosis: _____
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>Have there been any other cases of PD/PD+ in your family?              Yes.    No.
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>If "Yes", identify the relationship:_____________________________
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>Current Employment Status:             Full-time Employment
>                                               Part-time Employment
>                                               Illness Induced Disability
>                                               Retired
>                                               Volunteer
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>Current Occupation (if applicable) ____________________________
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>Occupation Before Diagnosis: _______________________________
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>Hobbies (list only those that might pose health/safety issues):
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>SECTION C:             MILITARY SERVICE
>
>TO ANSWER SECTION C:   CHECK IT.       WRITE IT.
>
>Military Service:      Stateside
>                       WW!!
>                       Korea
>                       Viet Nam
>                       Persian Gulf
>                       Other Assignments: _____________________________
>
>Were you at any time, without your knowledge, placed in an experimental
>area or
>situation?                     Yes.            No.
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