Parkinson's Foundation: Believe in Better

Groups who wish to be added to the Parkinson's Foundation local resource listings are required to complete the following online screening questionnaire:

Requests will be reviewed by staff once submitted. Please allow up to two weeks to receive a response.

*1.

Question - Required - Are you currently already posted on our resource list?

Yes, I am already listed but have a change to my group's information.

No, I am not listed but would like to be added.

2.

Question - Not Required - Group or program name

3.

Question - Not Required - Name of primary contact

4.

Question - Not Required - Phone number

5.

Question - Not Required - Email address

6.

Question - Not Required - Link to website (if available)

(Maximum response 255 chars, approx. 5 rows of text)

7.

Question - Not Required - Brief description of the program or group

(Maximum response 255 chars, approx. 5 rows of text)

*8.

Question - Required - Are you currently meeting in-person or virtually?

Location of meeting or class (note that the Foundation will not be listing specific addresses)

9.

Question - Not Required - City

10.

Question - Not Required - State

11.

Question - Not Required - Zip Code

12.

Question - Not Required - Is this class free or is there a fee?

13.

Question - Not Required - What year was this group established?

14.

Question - Not Required - What is the primary mission or goal of the group?

(Maximum response 255 chars, approx. 5 rows of text)

If this is an exercise program,

15.

Question - Not Required - is the class led by instructors trained or certified in a Parkinson's specific exercise?

16.

Question - Not Required - If so, which ones?

17.

Question - Not Required - Is the class led by certified/trained fitness professionals or other allied health professional?

18.

Question - Not Required - Is this group affiliated with a larger organization or non-profit?

Accepting terms and conditions (circle must be selected to submit this form):

*19.

Question - Required - Individuals acknowledge that inclusion on the Parkinson's Foundation resource listing is with the expectation that the program offered is provided with the highest standards for quality and safety. Additionally, the host organization/individual agrees to use transparent, supportive and open communication when speaking with others about the Parkinson's Foundation.

I Accept

Resource Listings Questionnaire (Heartland)