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Pool Change for Saturday (10/17): Lap Swim will be ending at 11:30am; Aloupis Pool will be closing at 11:30am for a private Splash Party Rental. We apologize for any inconvenience and appreciate your understanding.

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Evidence-Based Health Programs Contact Form

Thank you very much for your interest in our Evidence-Based Health and Support programs! Please fill out the form below and we will contact you promptly to help you find the program that best fits your needs!

Name*
First Last
Email*
Phone*
Please provide the best number for us to reach you.
I'm interested in the following programs:*
Check all that apply. If you're not sure, that's totally ok! We'll help you!
- Select All
- Arthritis/Bone Health Support
- Cardiac Phase III & IV Rehab
- Cardiac Disease Prevention
- Diabetes Prevention & Support
- Cancer Care & Support
- Parkinson's Support for Patients & Caregivers
- Alzheimer's Support for Patients & Caregivers
- NeuroHealth Support
- Exercise Programs for Older Adults
- I'm not sure! Contact me!
Has your doctor ever told you that you have a heart condition?*
- Yes
- No
- I'm not sure
Do you ever get unexplained pains in your chest at rest or during physical activity?*
- Yes
- No
- I'm not sure
Have you ever suffered a stroke?*
- Yes
- No
- I'm not sure
Do you ever feel so dizzy during physical exercise, that you lose your balance?*
- Yes
- No
- I'm not sure
Have you ever suffered an asthma attack requiring immediate medical attention, at any time over the last 12 months?*
- Yes
- No
- I'm not sure
Has your doctor ever told that you have muscle, bone, or joint problems?*
- Yes
- No
- I'm not sure
Do you have any other condition(s) that may make it dangerous for you to participate in physical activity or exercise?*
- Yes
- No
- I'm not sure
Do you already have a membership to the Bangor Region YMCA?*
Access to more than 70 group fitness classes each week is INCLUDED AT NO EXTRA COST as a part of your Bangor Region YMCA Membership!
- Yes
- No
How did you hear about Evidence-Based Health Support programs at our YMCA?*
Is there anything else you would like to share with us?

Bangor Region YMCA
17 Second Street — Bangor, ME 04401
207-941-2808

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