Medicare Exercise Program
Please complete this form to confirm your Medicare eligibility to participate in San Diego Oasis Wellness Center fitness classes. You will receive a confirmation email once activated in the San Diego Oasis registration system.

Please allow 5 business days for processing.
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First Name *
Last Name *
Email Address *
Phone# *
Date of Birth *
MM
/
DD
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YYYY
ZIP Code *
Please select the program who provides your fitness benefit *
Member Insurance Card ID# *
Please provide your program Fitness ID / Confirmation Code (this usually starts with the letter "A" and has 9 digits, for United, Aaptiv, SCAN, and Kaiser) This can also be given to you by your insurance provider. *
While you are free to attend classes at both locations, which location would you frequent? *
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