PB Sports Evaluation = Unlock your potential and gain that competitive edge!

Sports Performance Evaluation

Submit your online form today and we will call you to discuss how we can give you that competitive edge!
Name*
Mobile Number*
Address

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
Email*
example@example.com
Name of Child*
Child's Date of Birth*
How did you hear about us?*
Please read the list of possible traits below, then click under the option which applies most to you.

Selecting 1 indicates that you have no difficulty with the task.

Selecting 5 indicates that you have great difficulty with the task.

	1	2	3	4	5
Difficulty getting organised?
Do you forget sports gear, keys, phone?
Do you fidget?
Find it hard to concentrate?
Do you get frustrated easily?
Do you get Anxious/stressed?
Show aggressive behaviour?
Do you talk excessively?
Do you lack consequences?
Do you lose concentration during play?
Rigid body/poor flexibility?
Rituals before play?
Balance problems?
Slow reaction speed?
Find it difficult to communicate in play?
Find it difficult to read the game?
Do you interrupt when speaking to others?
Are you 'on the go' or act as if 'driven by a motor'?
Slow processing speed?
Do you talk excessively?
Do you become very frustrated over little things in life?
Do you shows aggressive behaviour?
Inappropriate speech/no filter?
Do you have difficulty holding eye contact?
Do you know what to say but can't get the words out?
Do you second guess your decisions on the pitch?
Do you have Inconsistent results?
Are you over critical of your game?
Is your passing of the ball accurate?
Is your judgment of force accurate?
Do you panic on the ball?

Please list your 3 main areas that you would like to improve in your game:
Please click 'Submit' below to return your completed form to Performance Breakthrough.

Contact details: -

Tel: 07790 245 145

Email: info@performancebreakthrough.co.uk

By clicking 'Submit' you are confirming that you have received and read the below information in relation to how our data is held by Performance Breakthrough Ltd. If you do not want to confirm and agree to this information, please let us know separately by email.
Data Privacy Policy

As a company Performance Breakthrough Ltd uphold the laws of GDPR.

The information we will hold will be held on the following mediums:-
- An Evaluation Form which will detail the areas you want to improve before starting any of our programmes/therapies. This evaluation will be updated at 6 week intervals. The quantifiable results of progress will be collated anonymously and used for research and evidence purposes.
- Testmonials / Quotations detailing the positive areas of progress. We may use these for marketing purposes, but only with your prior consent.
- Video clips showing progress. We will only take a video clip with your prior consent. We may use these for marketing purposes, but only with your prior consent.
- An invoice detailing the name of the payer and email address. This information will not be shared with anyone or any other organisation unless requested by you.
Your email address will not be shared with anyone or any other company and will only be used for communication, updates and a review survey between Performance Breakthrough Ltd and you.
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Sports Performance Evaluation