1. First a little background info...

A Bay Area first ever program designed by leading specialists in diabetes.

Dance Out Diabetes is a new San Francisco-based, 501 (c) (3) non-profit organization designed to help you prevent and manage diabetes. Founded by Theresa Garnero, Registered Nurse, Certified Diabetes Educator and one of the nation’s preeminent authorities on diabetes, and developed by a stellar panel of medical professionals along with people living with diabetes, Dance Out Diabetes will offer ongoing programs that focus on dance, nutrition, support and fun. We need your help in figuring out the best way to structure it.

If you have diabetes, or if you are ‘at risk’ for getting diabetes, or work in the field of diabetes, you will want to join the launch of Dance Out Diabetes at the City Views on the 4th Floor of the Metreon at 101 4th street (Between Mission and Minna Streets) in San Francisco on 11/14/10 from 1 to 4 pm. Monthly events are planned to follow at the Embarcadero Y in S.F. For those who live outside of San Francisco, know we plan on a virtual dance community in the near future.

Becoming a member of the launch of Dance Out Diabetes is easy; all you need to do is complete this brief survey that will give us a better idea of how to tailor programs to fit your needs. You do not have to be a good dancer to join! In fact this is a good opportunity to learn to dance and have fun.

As a way to say ‘Thanks for Completing the Survey,’ we will do two things:
1. Sign you up as an inaugural member of Dance Out Diabetes and,
2. Enter your name in a contest to possibly win $100 VISA gift card.


As a member of Dance Out Diabetes, we will keep you informed of upcoming events and send you information that will help you understand diabetes and stay inspired. You will hear directly from Theresa Garnero and other diabetes professionals through newsletters on the website, and via occasional podcasts and webinars.

So, let’s boogie!

* 1. Please give us your contact information.
This will be kept CONFIDENTIAL! If you wish to enter to win the $100 Visa card, we need to know how to reach you!

Please note your zip code is important, so we know wherein to consider our future dance events.

* 2. What is your age range?

* 3. What is your gender?

* 4. Are you interested in using dance to help manage your diabetes or prediabetes?

* 5. Which opportunities are you most interested in?

* 6. Are you currently under a physician’s care to help you manage and/or prevent diabetes?

* 7. Are you currently taking medication to control your diabetes?

* 8. Are you following your physician’s recommendations regarding exercise and diet to manage or prevent your diabetes?

* 9. If you are enrolled in an exercise program, has it been effective in helping you to manage and/or prevent diabetes?

* 10. Are you interested in joining Dance Out Diabetes and our programs that will help you to be active thru dance and learn nutrition tips to prevent and control diabetes?

* 11. As part of the Dance Out Diabetes Program, members who regularly attend will be evaluated to determine if the dance exercises and nutrition tips are effective. The evaluation will be accomplished by a short survey with each dance session. The survey will ask about your latest A1C level, pre and post dance glucose (if applicable), self-reported cholesterol levels and will include blood pressure and weight measurements, offered on-site. Your responses will be confidential and be tracked over time so you can see your individual results.

Are you willing to participate knowing this?

* 12. Are you willing to attend a dance on the 2nd Sunday of the month from 1-4 in San Francisco?

* 13. If you are willing to participate at the San Francisco studio, how many times do you think you will attend?

* 14. What days of the week are best for you to attend a dance program?

* 15. How often would you like to attend a dance program?

* 16. Our first Dance Out Diabetes program will launch at the Metreon near 4th and Mission (at 101 4th street Between Mission and Minna Streets) in San Francisco. Is this a convenient location for you?

* 17. Will you attend our launch Dance Out Diabetes on November 14th from 1-4?

* 18. How do you feel about dancing in a mixed group of women, men, all age groups, types of diabetes, physical abilities, and with your support team including friends, family and diabetes educators?

* 19. What kind of music would you like to dance to? Please check as many types as you would enjoy shaking your bon bon to (that's slang for dancing)!

* 20. What check your TOP THREE (3) favorite types of dance music (from the list below)?

* 21. The idea is to have several genres of music played at each event. An example structure might be:

1:00-1:15: Sign-in, warm-up
1:15-1:45: Dance instruction
1:45-2:00: Break, check glucose, hydrate, mingle
2:00-2:45: Free dance (different type of music)
2:45-3:00: Break, check glucose, hydrate, mingle
3:00-3:45: Free dance (different type of music)
3:45-4:00: Cool down, socialize, access nutrition handout that is related to the dance music (if Salsa music featured, we may have a Mexican recipe or tips on eating out at a Mexican restaurant or invite you to bring your favorite Salsa recipe).

What do you think of this tentative structure for Dance Out Diabetes?

* 22. Are you interested in a social media forum to connect with other people who like to dance as a way to prevent and manage diabetes (be able to interact with others via our website, post dance tips, individual insights, etc)?

* 23. Dance Out Diabetes hopes to reach others who may not be able to attend on-site dances at the studio. This would be accomplished through our website that is currently under development. What types of content would you like on the website? (Check all that apply)

* 24. Would you be interested in being a Dance Out Diabetes volunteer (we need CDEs, people with and without diabetes, people who live anywhere in the U.S.)?

* 25. How much would you be willing to pay for a 3-hour event?
(Check all that apply; keep in mind most dance programs cost at LEAST $10 every hour.)

* 26. What other suggestions do you have for the Dance Out Diabetes Board of Directors to consider?