Family History Form

For questions in section Neurologically Relevant Diseases, if known, please specify the age at onset and age of death(if deceased) for any family members diagnosed with the above labelled disease Please also use these abbreviations down below when specifying the family relation to the pertained questions:

M = Mother, F = Father, S = Sister, B = Brother, MA = Mother's Sister, PA = Father's Sister, MU = Mother's Brother, PU = Father's Brother, MGM = Mother's Mother, MGF = Mother's Father, PGM = Father's Mother, PGF = Father's Father

Name

Brothers (#):

Sisters (#):

Your Place In Birth Order:

Sons (list ages, not names):

Daughters (list ages, not names):

List Mother's Current Age. (If deceased, please list age of death and cause of death):

List Father's Current Age. (If deceased, please list age of death and cause of death):

Neurologically Relevant Diseases

Alzheimer's Dementia:

Other Forms of Dementia:

Parkinson's:

Aneurysm in Head:

Migraine Headaches:

Multiple Sclerosis:

Diabetes:

Other Neuromuscular Disease:

Other Neurological Disease:

Depression:

Stroke:

Heart Disease:

Cancer (Type):

Other Psychiatric:

Name

This field is for validation purposes and should be left unchanged.

Jody Hiltz, Front Desk Coordinator

Jody Hiltz has been Clinical Administrative Assistant for Dr. Marks since 2017. She received her Associate of Science Degree from Quincy College. Your can find her smiling face greeting you when you enter our office.

Elizabeth (Liz) Hitchings, Office Manager

Liz has been working for the practice for over 3 years. Prior to that she worked in skilled nursing facilities as a Life Enrichment Director/Dementia Practitioner. She loves supporting patients and their caregivers. Our practice offers expert level care in a community setting. Because of our association with an international research corporation we are also in a unique position to extend opportunities for treatments not otherwise available. She believes that it’s a pleasure to be a part of staff here who works as a team to provide education, support and as much as possible, a bit of amusement. Her goal is to help our patients maintain their independence and quality of life for as long as possible.

Kim Parker, Front Desk Coordinator

Years ago her grandfather was diagnosed with Alzheimer’s Disease then after taking care of her father her mother was diagnosed. She has worked in the medical field for over four decades as a Medical Biller but finds herself so fortunate to be working for this neurology practice as a Clinical Administrative Assistant in more of a “face to face” capacity with our patients. The years of experience supporting her mother through the disease was an education in what it takes to be a caregiver. She feels she developed more insight into what we can provide here to aid our patients and their support group. She feels she is especially blessed to be in an environment locally that can offer research trials that would not otherwise be accessible. She loves that the team here works to provide smiles every day to the ‘family’ that walks through our doors.

Morgan Tromblee, PA-C

Morgan Tromblee has been working in Alzheimer’s disease research as a sub-investigator with Dr. Donald Marks since 2022. She also works clinically in the outpatient neurology setting, primarily seeing patients with Alzheimer’s and Parkinson’s disease. She received her master’s at the MGH Institute of Health Professions Physician Assistant Program, and her bachelor’s in biology at the University of Vermont.

Elizabeth (Lizzy) Simpson, PA-C

Elizabeth (Lizzy) Simpson, PA-C

Elizabeth Simpson has been working in Alzheimer’s disease research as a sub-investigator with Dr. Donald Marks since 2021. She also works clinically in the outpatient neurology setting, primarily seeing patients with Alzheimer’s and Parkinson’s disease. Lizzy received her master’s degree in medical science at the Tufts University Physician Assistant Program, and her bachelor’s degrees at Providence College.

Kinan Hreib MD, PhD, MBA, Neurologist

Kinan Hreib MD, PhD, MBA, Neurologist

Dr. Hreib obtained his MD, Ph.D. and M.B.A. From Boston University and was trained in medicine and Neurology at Boston University Medical Center and Boston City Hospital. His professional life as a neurologist began at Lahey Clinic in Burlington, MA, where he was the director of Vascular Neurology for over twenty years, after which he became the chief of Neurology at Mount Auburn Hospital in Cambridge, MA before becoming the Chief Medical Officer for Baystate Health North. Dr. Hreib continued to see patients as a neurologist while the chief medical executive and later decided to join Donald Marks clinic on neurodegenerative disease in Plymouth.

Donald S. Marks, MD, Neurologist

Donald S. Marks, MD, Neurologist

For over 30 years, Dr. Marks has focused on the treatment of neurodegenerative diseases, specifically in the areas of Alzheimer’s and Parkinson’s disease. Dr. Marks has been the Principal Investigator (PI) in over 40 clinical trials with numerous pharmaceutical and imaging companies as well as with the National Institutes of Health (NIH). Dr. Marks is a member of the medical staff at the Beth Israel Lahey Health Hospital (BILH) Plymouth and the Nantucket Cottage Hospital. He is the founding Medical Director for the Division of Neurology at the BILH Plymouth.

Family History Form