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Intake Form
First name
Last name
Phone
Email
Birthday
Month
Day
Year
Multi-line address
Country/Region
Address
City
Zip / Postal code
How did you learn about us?
List your primary family members, their age, and briefly describe your relationships with each:
Have you ever integrated sports psychology/mental training into my sports preparation?
Yes
No
Do you have experience working with a sports psychologist or performance coach?
Yes
No
If yes, please explain:
What is your primary sport?
How many. years have you been playing/participating?
What is your primary position? Feel free to list multiple if needed.
Stress or anxiety level level leading up to a competition:
Stress or anxiety level level during competition:
Stress or anxiety level level after competition:
How would you rate your duration and consistency with sleep?
How would you rate your fueling habits?
How would you rate your hydration habits?
How would you rate your optimism related to what's possible for you?
How would you rate your overall discipline?
How would you rate your overall resilience or mental toughness?
Are you currently injured or dealing with injury of any severity level?
Yes
No
If yes, please explain:
Are you currently taking any medication?
Yes
No
If yes, please share what medication(s) and the purpose:
What do you want to achieve by working with us?
Submit
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