Apply to Train 1:1 with Judy Arazoza

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Email *

What is your full name and birthdate *

How long have you been training? *

Have you worked with a trainer before ? *

Option 1

Do you have any old or current injuries? Please describe in detail? *

Are you medically cleared to train? *

How many days per week can you100% commit to training *

2 days per week, not including cardio training

Three days per week, not including cardio training

4 days per week, not including cardio training,

4 days per week plus cardio training

Do you have access to gym equipment? Please list all that you have access to. *

Is this a home gym or a commercial gym?
*

Option 1

What time of day do you prefer to train? *

Have you had *

heart attack

heart surgery

cardiac catherization

pacemaker/ implantable cardiac defibrillator or rhythm disturbance

chest discomfort with exertion

unreasonable breathlessness

_____ dizziness, fainting or blackouts

_____ you take heart medications

Required

Do you have *

diabetes

_____ asthma

_____prescription medications : ______________________________________________________

_____ non prescription medications/ supplements:________________________________________

_____ are pregnant

_____ burning cramping in legs when walking a short distance

_____musculoskeletal problems that limit physical activity

_____ concerns about the safety of exercise

Required

Do you have *

female older than 55, have had hysterectomy, or are post menopausal

_____ smoker

_____blood pressure greater than 140/90

_____unknown blood pressure

_____on blood pressure medication

_____blood cholesterol level > 200mg/dl

_____ unknown cholesterol levels

_____have a close blood relative who had a heart attack or heart surgery before

(age 55 male or female before age 65)

_____you are physically inactive ( less than 30 minutes activity on 3 days /week)

_____ you are > 20 pounds over weight

_____ none of the above

Required

WHAT IS YOUR INSPIRATION AND DRIVING FORCE TO LIVE A FIT LIFE?
*

Currently on your ‘to read’ list or favorite book(s):

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