Worksheets, checklists, and assessments
The Every Victory Counts® Parkinson’s worksheets, checklists, and assessments are a great way to help you become more aware of the timing and characteristics of your symptoms, document those symptoms, note changes, and discuss them with your doctor. You can also log progress toward achieving your wellness goals, such as exercise, and see how far you’ve come and where you need to go.
To make them as useful to you as possible, we have designed them so you can fill them out right from your computer or tablet. Simply click on the field where you want to enter information and begin typing or click a box to check something off, then save your file. You can then print it out and take it to your next appointment, conversation, or treatment session.
Goal Summary For Doctor’s Visits
The best way to improve your health is by being an active participant. Complete this form during and between each visit with your Parkinson’s doctor or other healthcare professional. Record your action steps and progress between visits. Review your results with your wellness team at each visit.
My Symptoms Worksheet
Use this body map to circle symptoms or problem areas that you would like to discuss with your doctor or other members of your wellness team. While most of these are symptoms of Parkinson’s itself, some are side effects of Parkinson’s medications. On the second page, indicate how bothersome each symptom is for you. Bring the worksheet to discuss with your doctor at your next appointment.
Prepare for a Hospital Stay
This guide reminds you what lists to bring with you to the hospital (such as your current medications, symptoms, and more), what medications to avoid, what questions to ask before discharge, and more.
More Parkinson's Worksheets and Assessments
When you click on the title of each worksheet, it will automatically download to your computer. If your internet browser does not automatically show you downloaded files once they’re complete, check your “Downloads” folder for the file. Once downloaded, you will be able to fill the worksheets out right from your computer or tablet. Simply click on the field where you want to enter information and begin typing or click a box to check something off, then save your file. You can then print it out and take it to your next appointment, conversation, or treatment session.
- Parkinson’s Care Questionnaire
- Goal Summary for Doctor Visits
- Daily Medication Log
- Overall Medication Log
- Wellness Self-Assessment
- Pre-Exercise Self-Assessment
- Exercise Journal
- Nutrition Self-Assessment
- Parkinson’s Psychosis Self-Assessment
- Deep Brain Stimulation (DBS) Self-Assessment
- Our Relationship Self-Assessment
- Parkinson’s Home Safety Checklist
- Parkinson’s Travel Checklist
- My Symptoms Worksheet
- Bladder Worksheet
- Cognitive Wellness Worksheet
- Constipation Worksheet
- Dental Worksheet
- Dyskinesia and “OFF” Time Log
- Emotional Wellness: Anxiety
- Emotional Wellness: Depression
- Fatigue Worksheet
- Gait, Balance, and Freezing Worksheet
- Insomnia and Sleep Worksheet
- Low Blood Pressure and Dizziness Worksheet
- Speech and Communication Worksheet
- Swallowing Worksheet
- Sexual Dysfunction Worksheet