Healthy Living Request Form
Thank you for your interest in Healthy Living 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.
Format: (000) 000-0000.
Email
*
example@example.com
Member ID
*
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 Healthy Living 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)
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 Consult - complimentary 30 minute virtual conversation with our Registered Dietitian
Nutrition Counseling – collaboration on a personalized nutrition plan and S.M.A.R.T. goals with ongoing support, encouragement, and accountability from 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)
Aqua Arthritis is a structured water exercise program for individuals with arthritis
Pedaling for Parkinson's is a group cycle class offered several times a week for individuals with Parkinson's
Livestrong at the YMCA - 12 week cancer survivorship wellness program designed to help adult survivors rebuild strength, improve physical fitness, and connect with others who understand the journey (currently offered at YMCA Silver Spring)
None At This Time
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)
Anything else we should know?
Submit
Should be Empty: