PFNCA Questionnaire for Adding New PFNCA Wellness Classes
The PFNCA currently holds over 260 Wellness Programs monthly and is continually looking for opportunities to add new classes to better serve our community.  Below is a short questionnaire to provide more information to help guide this process.  Please provide the below information no later than February 15, 2020:
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Have you participated in PFNCA Wellness Programs such as Exercise for Parkinson’s, PFNCA Communications Club, etc.? *
Required
If yes, how long have you been participating in PFNCA Wellness Programs?   *
If PFNCA was able to secure funding to add new Wellness Programs, where would you like to see a class in the future (city/state)? *
PFNCA provides Wellness Programs in many different types of locations. Classes are often held in space donated by other organizations.  Do you know an organization in the city/state you referenced above that may be open to donating space for a PFNCA Wellness Program (gyms, senior living facilities, dance studios, etc.) that would be interested in partnering with the PFNCA (name of organization/city/state)?  Please provide as much as information as possible.
To start a new Wellness Program, a cohort of 12-25 people is ideal.  Do you know others living with Parkinson’s in the city/state you suggested above that may be interested in participating?
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PFNCA provides various formats of Wellness Programs.  Do you have a suggestion of the program format you think would be good for the city/state you suggested?
If other, please write which one.
The PFNCA gets numerous requests to provide Wellness Programs in a wide variety of cities/towns, more than our limited funding can support. Please provide more information as to why this location you suggested above may be best to allocate those funds.
If we had a young onset (diagnosis < 50 years old) PD class, would you attend?
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If you answer 'yes' to the question above, please provide the following information so that we can contact you as needed.  What is your name?
What is your email?
What city/state do you live in?
Please provide any additional information you wish to help us determine a location and format for a class.  Also, we may need to contact you to obtain more details for a new class in your area.  Please provide your contact information below.
Your name:
Your email:
Your phone number (best daytime number):
City/State in which you live:
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