Parkinson's Speech Evaluation Questionnaire
Please complete this questionnaire to help assess speech-related symptoms and communication challenges associated with Parkinson's.
Full Name
*
First Name
Last Name
How would you rate your overall speech difficulty?
*
No difficulty
1
2
3
4
Severe difficulty
5
1 is No difficulty, 5 is Severe difficulty
How clear do you feel your voice is when speaking?
*
Very clear
1
2
3
4
Very unclear
5
1 is Very clear, 5 is Very unclear
How would you rate your speech volume?
*
Very loud
1
2
3
4
Very soft
5
1 is Very loud, 5 is Very soft
How would you rate your articulation (ability to pronounce words clearly)?
*
Very clear
1
2
3
4
Very unclear
5
1 is Very clear, 5 is Very unclear
Do you experience fatigue while speaking?
*
Never
Rarely
Sometimes
Often
Always
In which situations do you notice your speech difficulties worsen? (Select all that apply)
Speaking in noisy environments
Speaking on the phone
Speaking with unfamiliar people
Speaking for extended periods
When tired
Other
How much do your speech difficulties affect your daily communication?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
Please rate the following aspects of your speech over the past week.
*
Rows
Never
Rarely
Sometimes
Often
Always
Difficulty starting to speak
1
2
3
4
5
Speech becomes slurred
6
7
8
9
10
Speech is monotone (lacks variation)
11
12
13
14
15
People ask you to repeat yourself
16
17
18
19
20
Additional notes or comments
Submit
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