1.Full Name

2.Facility Name

3.How many years have you held a PD Warrior licensee for?

4.How many clinicians...

Work in your facility (including those not PD Warrior trained)?

Are PD Warrior Trained?

Have completed level 3 or 4?

5.Approximately how many patients did you assess in the last 12 months?

6.On average what % of your patients are...

Early Stage 1/newly diagnosed?

Mid Stage 2 or3 > longer than 5 years?

Later Stage 4?

7.What is the average length of time a patient will have treatment for PD in your facility?

0-6 months

12-18 months

2-3 years

4-5 years

5+ years

8.How much do you charge patients per session? Please indicate the amount in your local currency

Initial Assessment?

60 minute consult?

10 Week Challenge

Group Classes/Circuits

9.What is the average spend of your PDW clients each year? Please indicate the amount in your local currency

10.What % of your patients do you recommend the 10WC? Why?

11.What % of your patients do you NOT recommend the 10WC? Why?

12.Do you recommend the 10WC bonus (free online 10 week challenge) to your patients? Why? If not, why?

13.On the Scale of 1-5 (with 1 being poor and 5 being excellent), how do you rate the following?

1

2

3

4

5

10 Week Challenge

1

2

3

4

5

INSIGHT into PD Online Conference

1

2

3

4

5

PD Warrior Website

1

2

3

4

5

Licensee Hub

1

2

3

4

5

PD Warrior Support

1

2

3

4

5

14.Do you record or track patient gains, wow moments or achievements and or use video or photo formats

Yes always

Sometimes

No

15.What has been the most successful method of promotion to build your PD Warrior patient base?

16.Do you offer telehealth sessions?

Yes

No

17.What do you find the most valuable about the PD Warrior program?

18.What do you find the least valuable about the PD Warrior program?

19.What else could PD Warrior do to best meet your company needs?

20.Is there anything else that you would like to feedback?