Pedaling for Parkinson's Program
This evidence-based program as shown those to cycle regularly in the Pedaling for Parkinson's Program can reduce their Parkinson's Symptoms by 35%.
Name
*
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you been medically cleared to engage in physical activity?
Please Select
Yes
No
I am not sure
Are you a current YMCA member?
Yes
No
Are you currently living with Parkinson's or a caregiver of a
Yes, I have Parkinson's
No, I am a caregiver of someone with Parkinson's
How did you hear of the YMCA Pedaling for Parkinson's Program?
Please Select
Self (decided to on own)
Non-primary care health professional
Primary Care Provider/Office
Community-based organization/Community Healthcare Worker
YMCA Staff
Family or Friend
Employer or employer's wellness program
Insurance Company
Media (new, advertising or social media)
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