Full Assessment Enrollment Form

Schedule Assessment

Assessment Protocol

Bod Pod or Skinfolds?

Lifestyle Coaching

Ogden, Utah

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Full Assessment Enrollment Form

Please note this form may not work in browsers other than Internet Explorer. Please e-mail our office to enroll if you are unable to use the following form.

First Name

Last Name

W#

Department

WSU Extension

E-mail address

Mail Code

Employment Status

If you are a spouse, please enter your spouse's name

Home Phone Number

Fitness Assessment Preferred Day and Time (one hour)
If you choose a Thursday morning appointment for your fitness assessment, you do not need to select a blood work appointment--your blood work will automatically be scheduled at the same time.

Blood Work Preferred Day and Time (15 minutes)

Preferred Contact Method

Body Composition Method

You will be contacted via your preferred method with appointment information within 24 business hours. To make special requests for other appointment times or accommodations, please make suggestions below.

Weber State University, Employee Wellness Program
Ogden, Utah 84408-2801
801-626-6480, wellness@weber.edu