Essential Tremor Survey

*At what age did your tremor symptoms appear? A diagnosis is not required. Please check what applies! *

Please choose all that apply of your race/ethnicity/national-origin. *

A. Caucasian - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. B. African-American -A person having origins in any of the black racial groups of Africa. C. Latino or Hispanic - A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.” D. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. E. Native American- A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. F. Native Hawaiian or Pacific Islander - Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. G. Jewish Origin

The purpose of this research project is to collect general information about Essential Tremor.
You are invited to participate in this research project because you have Essential Tremor.
Your participation in this research study is voluntary.
The procedure involves filling out the online survey.
Your responses will be confidential, however it will be used in a data base. Any identifiable information about you as an individual will remain confidential.
We will do our best to keep your information confidential. All data is stored in a password protected electronic format.
If you have any questions about the questionnaire, please contact Team DSF.
Filling out the information means you voluntarily agree to participate

Essential Tremor Information Population Data survey