With Discover Activa DBS, you'll receive and have access to the following: - An informative email newsletter
- Activa DBS literature and DVDs
- Ask An Expert
- Activa DBS Ambassadors
- Activa DBS Events
- Physician Locator

Discover Activa® DBS

To learn more about Activa DBS and how it might help you or someone you love, join Discover Activa DBS today. This free Medtronic program will be tailored to ensure that you're getting the information you want and need to help you decide if Activa DBS might be right for you or a loved one.

Sign up now to Discover Activa DBS.

* Indicates required field

* First Name
* Last Name
Patient First Name
Patient Last Name
* Address
* City
* State
* Zip
* Email
* Phone

* What year were you diagnosed with Parkinson's disease?

* What is your age?

* Do you experience troubling "off" periods (periods when medication is not helping enough and you are experiencing symptoms)?
Yes
No

* Do you experience troubling dyskinesias (involuntary excessive movements)?
Yes
No

* How many doses of dopaminergic drugs (Levodopa, Sinemet, Stalevo, Parcopa) do you take in a typical day?

* Do you experience any of the following troubling side effects from your medications, despite having tried several drug combinations? (sleepiness, nausea, hallucinations, confusion/other thinking problems, light-headedness upon standing, behavioral/personality changes)
Yes
No

* Do you currently have an Activa DBS system?
Yes
No

Who is the physician treating your Parkinson's disease symptoms?

* I have read the Important Safety Information regarding Activa DBS.     

By providing this information, you are granting Medtronic permission to add your contact information to its database to receive information about Activa Deep Brain Stimulation. You may revoke this permission at any time by emailing support@activadbs.com or sending a request in writing to:

Medtronic, Inc.
3850 Victoria Avenue, V255
Shoreview, MN 55126

In every communication you receive from us, you will be given clear instructions on how you can elect to no longer receive mailings from the Medtronic Discover Activa DBS program.

Important: Medtronic respects the confidentiality of personal information. We assure you that we will not share your personal information, except as otherwise noted in our privacy policy located at www.medtronic.com/statements/privacy.html or in these communications.