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  @essential tremor.org:  publications:  information:  Tremor Questionnaire
If you shake or tremble, please answer the following questions, courtesy of Abe Lieberman, M.D., of the National Parkinson Foundation Inc. This questionnaire has not been scientifically validated; any conclusions drawn from this questionnaire reflect opinion, not fact. This questionnaire is not a substitute for a visit with your physician.

Your Name:  
Your Email Address:  
If you'd be interested in having someone contact you regarding a more detailed questionnaire, which will be included in a research study, please check here: and give us your mailing address and telephone number:
Phone:  
Address:  
City, State, ZIP:  
Yes No
1. Do your hands shake, quiver or tremble?  
2. Does your head shake, quiver or tremble?  
3. Does your voice quiver or tremble?  
4. Do your legs shake, quiver or tremble?  
5. Does your trunk, chest or belly shake, quiver or tremble?  
6. Do your hands shake when you pickup a glass and bring it to your lips?  
7. Do your hands shake or tremble when you hold them in front of you?  
8. Do your hands shake or tremble when you perform fine movements?  
9. Is there a family history of tremor?  
10. If your hands tremble does an alcohol drink decrease the trembling?  
11. Has anyone said you have essential, familial or hereditary tremor?  
12. Have you taken propranolol (Inderal) or primidone (Mysoline) for tremor?  
You answered "Yes" to of 12 questions for a score of %
  Probability of Essential Tremor
or Parkinson disease:
0 - 50% Low
51% - 75% Moderate
76% - 100% High


To interpret these results please select one of the following:

Shaking or trembling has been present for less than two years
  If shaking or trembling has been present 1-23 months, such shaking or trembling could be caused by temporary conditions such as:
 • Increased anxiety or stress
 • Certain medications you may be taking
 • Caffeine excess or caffeine withdrawal
 • Nicotine or smoking excess nicotine withdrawal
 • Alcohol excess
  Such shaking or trembling could also be caused by conditions such as:
 • Endocrine imbalances
 • Electrolyte imbalances
 • Hormonal imbalances
  Without being seen and examined by a physian, the cause of your tremor cannot be determined. This can only be determined by your doctor. You must discuss the shaking or trembling with your physician.
Shaking or trembling has been present two years or more
  If shaking or trembling has been present for two or more years and you do not have an endocrine imbalance or a hormonal imbalance, you may have essential tremor or Parkinson disease.