Client Information - Performance Mindset

Name

First Name

Last Name

Phone

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###

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Date of Birth

Sport

How did you hear about me?

Injury

Have you ever had a sports injury that affects your mindset? If so, briefly describe please. Include information about whether you are medically cleared to practice / play currently.

Success

What would be an indicator of "success" after completing this Athletic Mindset Program.

Questions or Concerns

Do you have any questions or apprehensions? Briefly describe please.