Wellness Request Form
Thank you for your interest in Wellness Services at the YMCA of Metropolitan Washington. Upon completion, a team member will contact you within 48 business hours. This form will take approx. 4 minutes to complete.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Home Branch
*
Please Select
YMCA Alexandria
YMCA Anthony Bowen
YMCA Arlington
YMCA Bethesda-Chevy Chase
YMCA Fairfax County Reston
YMCA Silver Spring
What is your preferred method of communication?
*
Phone
Email
What is the best time of day to initially reach you?
*
Morning
Afternoon
Evening
What Wellness Services are you interested in? (select all that apply)
*
Wellness Consultation - 30 minute goal setting discussion, recording health measurements, and developing a workout schedule for your first 30 days at the Y
Coach Assisted Workout - 60 minute session with a wellness coach to customize your goals, objectives and strength equipment preferences
Equipment Orientation - opportunity to practice using cardio equipment in the Wellness Center
Youth/Teen Orientation (MANDATORY for ages 12-17 years old)
Personal Wellness Training (Individual/Partner/Small Group/Pilates Reformer)
What are a few of your health journey goals?
When are you available to meet (list as many days and times that you are available)?
*
Weekday Morning (before 10:00am)
Weekday Afternoon (between 10:00am-3:00pm)
Weekday Evening (after 3:00pm)
Weekend Morning (before 10:00am)
Weekend Afternoon (between 10:00am-3:00pm)
Weekend Evening (after 3:00pm)
Please indicate your interest in our Community Health Programs (select all that apply).
*
Blood Pressure Self-Monitoring (BPSM) - virtual 4-month long program designed to reduce your blood pressure.
YMCA Diabetes's Prevention Program (DPP) - virtual year long program designed to reduce the risk of diabetes.
Nutrition Counseling - complimentary 30 minute virtual consult with our Registered Dietitian.
Full Circle Health Program - 8 week program offering comprehensive support and education to assist participants in reaching their goals! (currently offered at YMCA Silver Spring and YMCA Reston at Fairfax County)
None At This Time
Anything else we should know?
Submit
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