Wellness Coach Request Form

Please use the form below to request a Wellness Coaching or Personal Training Session. Wellness Coaching is a free service to Y Members; Personal Training is billed by the hour.

Name*

Phone Number

Best Time for Phone Call

Email

Repeat Email

Preferred Contact Method*

Please check all that apply:

I need an orientation of the equipment
I would like to have a personalized program designed
I have new goals and need further assistance
I am interested in a one-on-one orientation with a personal trainer (Member Rate - $20/Hr)

Best Days to Meet with a Coach

Best Times to Meet with a Coach

Morning
Afternoon
Evening

Comments or Questions