Difficulty Signing and Filling in Forms: How People with Parkinson's Disease Can Handle Bank and Legal Documents

For many families living with Parkinson's disease, the most discouraging scene often takes place at the bank counter. The signature gets smaller, the writing is shaky and crooked, it does not match the bank's record, and the document is sent back to be signed again. A carer naturally worries that if the patient cannot even sign their own name, the money and documents in their name cannot be dealt with. In fact, in the great majority of cases there is a way to solve it. Difficulty signing and filling in forms is a practical problem that can be taken apart layer by layer, and there is no dead end.

This article is a practical follow-up to the earlier article on micrographia (writing that gets smaller). It looks at three levels: (1) the writing itself, covering which aids an occupational therapist can provide and how much writing training really achieves (and which limits should not be overstated); (2) the bank level, covering how Hong Kong's new 2026 accessibility guidelines for banks accept chops, electronic signing, witnesses and other alternatives; and (3) the legal level, covering why making an enduring power of attorney (EPA) as soon as possible, while the person is still mentally clear in the early stage of illness, is the key point about timing.

Common causes of difficulty signing

Parkinson's disease affects writing mainly through three overlapping factors: resting tremor, which makes the strokes shake; muscle stiffness, which makes hand movements less smooth and writing an effort; and, most characteristic of all, micrographia, in which slow movement with a narrowing range makes the writing smaller and smaller. Together these make it easy for a signature not to match the identity card record, or for the person to run out of strength halfway through a signature.

It needs to be said clearly, though, that nearly all of this is a problem of carrying out the movement (getting the writing onto the paper), and it is not a problem with the person's wishes or ability to judge. In nine cases out of ten, a person with Parkinson's disease whose signature is no longer neat still understands what they are doing, and knows exactly how they want to move money and deal with documents. Recognising this difference is very important, because the solutions work on two fronts. At the level of writing, aids and training reduce the load on the hand. At the level of documents, the bank's alternative ways of signing are used well and legal planning is done early.

Level 1: the writing itself, and writing aids from occupational therapy

The first step in dealing with writing difficulty in occupational therapy (OT) is never to tell the patient to buy an expensive pen. It is a full assessment, looking closely at how tremor, muscle stiffness, grip strength and sitting posture affect writing, and only then choosing aids to match the problem. Common aids that have a rationale behind them include:

• Thick pen grip / thick pen barrel—A thicker barrel reduces the demand on fine grip in the hand, so the pen is held more steadily and with less effort. It is especially helpful for patients with muscle stiffness or weaker grip.
• Weighted pen—Adding weight to the pen can help some patients steady a tremor and reduce drifting of the pen tip. For others the effect may be small, so it has to be tried in person to see whether it suits, and it cannot be assumed to work.
• Non-slip mat / magnetic clipboard—A non-slip mat can hold the paper in place, so that the other hand does not have to press hard on the sheet, and the patient can put their strength into writing.
• Sloped writing board—A sloped board can improve sitting posture and the angle of the wrist, and reduce the tiredness of writing for a long time.
• Visual / auditory cues—Using lined paper with parallel lines, a thick-coloured pen, or writing to a beat can help the brain regain the size of the movement (see the article on micrographia for details).

When it comes to the value of occupational therapy (OT) for improving overall daily function in Parkinson's disease, however, the scientific evidence is much firmer. A large randomised controlled trial of home-visit occupational therapy (OTiP, Sturkenboom et al., 2014, n=191) showed that after 10 weeks of individualised home OT, patients' self-rated daily activity performance (COPM) improved clearly, with a difference between groups of about 1.2 points (95% CI 0.8–1.6, p<0.0001). International clinical guidance (NICE NG71, 2017) also recommends considering referral to an experienced occupational therapist early in Parkinson's disease. In other words, OT has strong evidence for helping people cope with everyday tasks, whereas the evidence is quite weak for the hope that a single writing gadget can cure micrographia. The two must be kept apart.

Level 2: bank procedures, and the new 2026 Hong Kong guidelines on chops, witnesses and electronic signing

The update in bank policy is perhaps the best news of the last two years. On 21 January 2026 the Hong Kong Association of Banks (HKAB) and the Hong Kong Monetary Authority (HKMA) jointly issued the 《長者友善銀行服務指引》 (guidelines on age-friendly banking services) and the 《無障礙銀行服務實務指引（第二版）》 (Practical Guide on Accessible Banking Services, second edition). They clearly require banks to accept electronic, chop or handwritten signatures, to offer a witnessing arrangement or the presence of several staff members to help, and to put a total of 53 accessibility measures in place within 18 months. For people with Parkinson's disease who struggle to sign, this opens several alternatives that are both compliant and practical.

Patients and family members can discuss the following arrangements with the bank. Keep one general rule in mind: contact the bank in advance and make an appointment. This is always better than going straight to the counter and negotiating there.

1. 1
   Update the signature style in advance

   While the patient can still write, go to a bank branch first and register a simpler signature style that is easier to repeat, for example fewer characters, or neat block letters. This reduces the chance of a signature not matching the bank's record later because of tremor or smaller writing.
2. 2
   Chop or signature stamp + witness

   For everyday deposits, withdrawals or signing ordinary contracts, a chop or signature stamp can be used in place of a handwritten signature. However, banks generally require the person's authorisation and a bank staff member present as a witness, and stamping a chop alone is not enough.
3. 3
   Thumbprint (the last resort)

   If the patient cannot sign or use a chop, then, as is generally done in Hong Kong (for example when signing a tax return), the person can use a thumbprint instead of a signature. A witness aged 18 or over must be beside the person, and the witness's name and identity card number must be written on the document.
4. 4
   Staff help / several people present

   Under the latest guidelines, a customer can ask the bank to arrange a witnessing procedure or to have several staff members present to help, which makes the document easier to accept and gives both sides more protection.

What the Electronic Transactions Ordinance (Cap 553) says about electronic signatures

Pressing keys is easier than holding a pen when there is a tremor, so many people ask whether signing electronically on a phone or tablet settles everything. This depends on the type of document. Under Hong Kong's Electronic Transactions Ordinance (Cap 553), an electronic signature on an ordinary commercial contract has full legal effect, and paying bills, opening accounts and signing ordinary contracts all go through. The ordinance also expressly excludesa series of very important documents, and states that they cannot be replaced by an electronic signature. This matters especially for people with Parkinson's disease, because the documents they most need to deal with are often exactly this kind.

Level 3: timing, and making an enduring power of attorney (EPA) early while the person is mentally clear

If only one point can be remembered from this article, it is this: an enduring power of attorney (EPA, the Enduring Powers of Attorney Ordinance, Cap 501 of the laws of Hong Kong) must be made early. This is closely tied to how Parkinson's disease develops. The medical literature points out that cognitive decline in Parkinson's disease is usually slow and gradual, and patients mostly keep clear cognitive ability in the early stage of the illness. As the disease advances, however, the risk of dementia or cognitive impairment rises. Within 10–20 years of diagnosis, about five to eight in ten patients develop cognitive impairment (Aarsland et al., 2021).

In other words, the early to middle stages, when a person with Parkinson's disease is mentally clear and has mental capacity, are the best window for making an EPA. While the mind is clear, the person can appoint someone they trust (the attorney). If they later lose mental capacity, the attorney can manage property and financial affairs as the power of attorney directs. If this is left until cognitive ability has declined, it is too late. By then it may not be possible to make the document at all, disputes are more likely among family members, and in the end complicated court procedures may be needed.

Common misunderstandings

The following clears up the blind spots that are most commonly misunderstood and most likely to leave a document ineffective:

"A chop is a cure-all, and stamping it makes it valid"

No. At a bank, using a chop generally needs the person's authorisation and a staff member as a witness. For important documents such as a power of attorney, an estate or a property transfer, a chop alone may not be accepted.

"If the signature shakes, the bank will never accept it"

No. The 2026 guidelines already require banks to accept electronic signatures, chops, or handwritten signatures with a witnessing arrangement. Contacting the branch in advance and booking a time solves most cases.

"An electronic signature can sign an EPA"

No. Enduring powers of attorney (EPA), wills, deeds and cheques are not covered by the Electronic Transactions Ordinance and must use traditional handwritten signing and witnessing.

"One magic pen from OT cures micrographia"

This overstates the effect. The research evidence for writing training is weak, the actual effect is small, and it may not last (Gardoni 2023). The real role of aids is to reduce the burden of writing for the patient, and not to cure micrographia.

Who does what: the occupational therapist, the solicitor and the bank

These three fields each have their own role, and the safest course is to use them together. The list below shows whom to turn to in different situations:

The home-visit occupational therapy team at Nova Health can go to the patient's home to carry out a home writing assessment, provide suitable aids and training in using them, and can help with preparation for the writing needed for bank or legal documents (for example practising a new signature style with the patient, or adjusting the writing posture). Please note that these services are functional support only and do not amount to legal advice. Details of legal effect and bank procedures must be handled by a solicitor and the bank.

Local support resources and referral routes

Besides rehabilitation treatment and sorting out documents, the following local organisations offer patient education, support services and free legal information, and readers may contact them as needed: the Hong Kong Parkinson's Disease Association (香港柏金遜症會), the patient education information of the Hong Kong Movement Disorders Society (HKMDS), and the 柏動愛 Parkinson's disease care programme of the Hong Kong Society for Rehabilitation (香港復康會賽馬會「柏動愛」柏金遜症關懷計劃). For legal questions, the Community Legal Information Centre (CLIC) / Senior CLICwebsite has a general introduction to enduring powers of attorney. Many people assume that difficulty signing is a dead end that nothing can be done about. In fact, with early recognition and early planning, the patient's function in daily life and independence can be protected.

Frequently asked questions