MJJ

Caregiver questionnaire

Help shape Parkinson caregiver support that is useful without becoming another job.

This form asks caregivers about daily friction, appointment priorities, caregiver burden, app/game support, permissions, alerts, and safety boundaries.

Start caregiver questionnaire
Privacy note: Do not include names, exact birth dates, addresses, record numbers, clinician names, exact medication doses, or identifiable case stories.
Medical safety note: This site is for education and evidence translation. It does not replace a clinician, diagnosis, treatment plan, medication advice, or emergency care.

Storage

With consent, responses are stored in protected Cloudflare D1 storage for MJJ product discovery. Optional email is stored separately only if follow-up is selected.

Parkinson caregiver questionnaire

Caregiver support, burden, and caregiver-mode design.

This is product discovery and research planning, not medical care, diagnosis, triage, or medication advice.

About you and your role
What best describes your caregiving role? *
How often do you observe or help with Parkinson-related needs?
Movement, daily activities, and safety
Walking/balance
Freezing of gait
Falls or near-falls
Transfers/chair/bed
Dressing/washing
Eating/swallowing
Speech/voice
Which activities most often need help?
Thinking, mood, sleep, and medication routine
Memory/thinking
Mood/anxiety
Sleep
Hallucinations/illusions
Apathy/motivation
Dizziness/fainting
Constipation/urinary symptoms
Caregiver strain and support
Apps, games, and caregiver mode
Which digital features would be useful?
What would you want to do in caregiver mode?
Appointment priorities and follow-up
Would a short caregiver summary for appointments be useful?
May we contact you for follow-up questions or prototype testing?

Before submitting

  • This is product discovery and education planning, not medical advice.
  • Do not use this form for urgent symptoms, diagnosis, treatment choices, or medication decisions.
  • Please avoid identifying details about yourself, the person with Parkinson, clinicians, or care teams.
  • Your response will be stored for MJJ discovery if you submit with consent.

You can request deletion later using the reference ID returned after submission.