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ONE+ PICKLEBALL CLUB

IS NOW ACCEPTING FITNESS & WELLNESS PROGRAMS

Do you have health insurance benefits? Pickleball might be covered!

1-web-and-social-media-flyer-wellness-eng-spa

One + Pickleball Club | Premier Indoor Pickleball in St. Cloud, Florida

Ask us how to check your eligibility today!

Diana Polanco – Wellness Coordinator – wellness@onemorepickleballclub.com – (904) 469-6197

ELIGIBILITY REQUEST

Please complete all required fields below.If you do not know your Fitness ID or Confirmation Code, select your wellness program and upload a photo of your insurance card.

"*" indicates required fields

Member Name*

First Name Last Name

Date of Birth*

Phone Number*

Please enter a valid phone number.

Home Address*

Street Address, City, State, Zip Code

Email Address*

example@example.com

Insurance Coverage Type*

Medicare

Medicare HMO / Medicare Advantage

Medicaid

Commercial Insurance

Not Sure

Which Wellness Program Do You Have?*

SilverSneakers

Renew Active

Silver&Fit

Active&Fit

One Pass

Wellhub

Other

Not Sure

Please select the wellness program*

Silver&Fit

Wellhub

SilverSneakers

OnePass

Active&Fit

Member ID Number*

Fitness ID / Confirmation Code*

I do not know my Fitness ID or Confirmation Code

Upload Insurance Card

Max. file size: 128 MB.

Upload Back of Card

Max. file size: 128 MB.

Emergency Contact*

Emergency Contact Phone Number**

Please enter a valid phone number.

Authorization*

I authorize the OneMore Pickleball Club to verify my wellness program eligibility and contact me if additional information is needed.

One+ Pickleball Club

1790 E Irlo Bronson Memorial Hwy, St. Cloud Florida 34771
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