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FAX 608-833-9114
3315 Prairie Glade Rd
Middleton, WI 53562
Phone 608-833-9336
Please reply in format
1 - A
2 - A
3 - F
Demographics
1. I am a listmember.
A. Yes
B. No
2. I am a US resident.
A. Yes
B. No
3. I am
A. A person with Parkinson's Disease (PWP)
B. A caregiver residing with a PWP (relative)
C. A caregiver residing in with of a PWP (non-relative)
D. A relative of a PWP not providing live-in care
E. A professional working with PWP
F. Other interested person
4. I consider myself a member, or affiliated with (LIST MORE THAN 1 if
needed)
A. APDA
B. PDF
C. UPF
D. PAN
E. NPF
F. An independent support group with no national affiliation
G. Unaffiliated with any of the above
H. I have been asked to serve on the Steering committee of the
PATIENT CONGRESS and Accepted
I. I have been asked to serve on the Steering committee and
refused.
ISSues regarding patient congress
5. I support the idea in principal of a Patient Congress open to all
PWP and caregivers regardless of Affiliation to develop a unified
political agenda and to set common goals and encourage cooperation
between the many PD organizations.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
6. If possible I would try to attend such a Congress.
A. YES
B. No
7. I believe that the EXISTING PD organizations work well and in a
coordinated way in advocating for the interests of PWP.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
8, I feel it is important for the Success of a Patient Congress that the
steering committee be perceived as not supporting the agenda of a
particular organization.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
9. As a group (separate from the issue of sponsorship)I feel the
individuals chosen by Jim Cordy can represent my interests in planning
the Patient Congress.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
10. With NPF Hosting the committee and providing transportation, lodging
and entertainment etc,I think that the steering committee (all who have
reputations as being quite independent) will be influenced toward
supporting NPF positions and Interests:
A. Totally and completely toward NPF
B. Strongly be influenced toward NPF
C. Mild subtle influence toward NPF positions
D. Will be able to maintain total independence
E. Mildly be influenced against support of NPF positions
F. Strongly influenced away from NPF positions
G. tOTALLY AND COMPLETELY opposed
11. I believe that NPF Sponsorship without attempting co-sponsorship is
helping the PATIENT CONGRESS attain its goals.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
12. Since NPF is the strongest organization and there is such animosity
between individuals in different groups I support the strengthening of
NPF and not worrying about the concerns of the other groups since there
is no hope of cooperation.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
13. I think that the Congress would have the best chance of success if:
A. Continue with plans of sole sponsorship by NPF
B. Expand sponsorship to all groups soliciting funds from the PD
groups and other sources and continue with plans to have the
coordinating committee in Miami.
C. Expand sponsorship to all groups soliciting funds from the PD
groups and other sources and have the committee meet on neutral
territory.
D. Pick a new committee and start over.
E. The Congress is a Good idea that is doomed to failure
F. The Congress is a bad idea
14. The generous financial support of NPF for the patient congress
increases my regard and support for NPF.
A. Strongly Agree
B. Moderately Agree
C. Mildly Agree
D. I am neutral or don't have an opinion
E. mildly disagree
F. moderately disagree
G. Strongly disagree
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CHARLES T. MEYER, M.D.
Middleton, WI
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