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DO YOU HAVE a personal story?
STALEVO is indicated for certain patients with Parkinson's disease experiencing symptom reemergence due to levodopa "wearing-off."

 

 

 

 
If you have been taking STALEVO and would like to tell us your story, we would like to hear from you. If you or someone you know would like to participate, complete the form below and click on the "Submit" button, or call toll-free at 1-877-427-1407.

The personal information you supply to us will be shared with and among our business partners, affiliates, and agents to provide you with information, products, programs, and services and to conduct market research. Your information may be combined with information from other areas or programs in which you participate. Your information will not be used by any of our business partners, affiliates, and/or agents for their own separate purposes. You have the right to cancel your participation at any time by calling 1-888-669-6682 Monday - Friday, 8:30 AM - 5:00 PM EST. For further information about Novartis privacy practices, please review our privacy policy.

  
*First Name: *Last Name: Gender:
 
*E-mail: Please do not supply us with a wireless e-mail address.
 
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*Date of birth:      
 
1.Which best describes you?
patient
care partner
 
2. What medication do you take for PD?
STALEVO Azilect® (rasagiline mesylate)
Sinemet® or generic equivalent (levodopa/carbidopa) Eldepryl® (selegiline HCl)
Sinemet® CR (levodopa/carbidopa) Mirapex® (pramipexole dihydrochloride)
Symmetrel® (amantadine HCl) Parlodel® (bromocriptine mesylate)
Zelapar® (selegiline HCl) Requip® (ropinirole HCl)
Don't know Other
 
3. When were you diagnosed with PD?
Less than 1 year ago
1-5 years ago
6-10 years ago
More than 10 years ago
 
4. What type of health care professional do you typically see for the management of PD?
Movement disorder specialist
Neurologist
Primary care provider
Physician assistant
Nurse practitioner
Other
Don't know/not sure
 
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Azilect is a registered trademark of Teva Pharmaceuticals USA, Inc.
Eldepryl is a registered trademark of Somerset Pharmaceuticals, Inc.
Mirapex is a registered trademark of Boehringer Ingelheim Pharmaceuticals, Inc.
Parlodel is a registered trademark of Novartis Pharmaceuticals Corporation.
Requip is a registered trademark of GlaxoSmithKline.
Sinemet and Sinemet CR are registered trademarks of Merck & Co., Inc.
Symmetrel is a trademark of Endo Pharmaceuticals Inc.
Zelapar is a registered trademark of Valeant Pharmaceuticals International.

 

     
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