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Membership Application

Becoming a Wellness Center Member just got easier. Follow the instructions below and you'll be on your way to better health!

  • Fill out the application below.
  • After you submit your application, print the confirmation screen and bring it with you the first time you visit the Wellness Center.
  • To complete your membership, you will need to fill out a health history survey and receive your membership card.

A membership representative will be in contact with you via email within one business day after receiving your application to answer any questions that you may have. 

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Member Information

 
 
 
 
 
 
*Male or Female:  
 
 
 
 
 
 
 

Health History

Please indicate if you have been diagnosed or experience any of the following.

*Heart Disease / Hypertension
   
*Have you ever been diagnosed with any form of cancer?
   

Stroke
   
*Epilepsy or Seizures
   
COPD, Asthma or Emphysema
   
*Are you pregnant or post natal?
   

*Diabetes
   
Diabetes type
      
Diabetes medications
         
*Smoking or quit within the last 6 months
   
*Chest pain within the last month
   
*Have you lost consciousness or fallen as a result of dizziness?
   
*Are you under a doctor's supervision for any illness or physical condition that may affect your ability to exercise?
   
*Do you have muscle/bone/joint problems that are aggravated by exercise?
   



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Family Members

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Type of Membership

 
 
 


* Denotes a required field

- All membership dues are paid on the 10th of the month or quarter.
- Cancellations require a 30 day notice.



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