Fitwell Program Request
Please fill out this form if requesting a program with UCLA FITWELL.
What is today's date? (Date you are filling out this form)
Program you would like to request? *No cost, except chair massage and recurring requests
Portable Gym Kit Workshop: Everyone receives a resistance tube and yoga strap; interactive lecture with workout
Deskercise: Learn fun, simple workouts you can do right at your desk!
Back Health and Optimal Posture through Alexander Technique
Stress Relieving Strategies: Meditation and Breathwork
Meditation and Breathwork
Mindful Eating: Applying the principles of mindfulness to how we eat
Creating a Positive Relationship with Food and Fitness
Healthy Goal Setting for your Well-Being
Fit Break: Short break of fitness and stretching during a staff meeting or event
Total Body Workout
Chair Massage (Costs $70/hr per massage therapist)
Other: Custom workshop idea
What date would you like your workshop to be held? (*Please select an ideal date for your team. We are usually able to accommodate you ideal date.)
Alternative Date (in case for any reason we can't accommodate the ideal one listed.)
Ideal Start Time for the Program
Ideal End Time for the Program
If you requested chair massage, how many massage therapists would you like to request for the time frame listed above?
Any other details you would like to provide?
If you are requesting chair massage, would you like to pay by invoice or University Recharge?
If paying by University Recharge, please provide your account info here. Make sure to provide ID, account and fund.
Thank you for programming with us!
A copy of your responses will be emailed to the address you provided.
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