Client Background Information
Please complete the form below to apply for an opportunity to work with Jeff Greenwald.
Full Name (client)
First Name
Last Name
Full Name (parent)
First Name
Last Name
Email
example@example.com
Today's Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Hour
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Minutes
AM
PM
AM/PM Option
Client's Age
How did you hear about Jeff and how familiar are you with his approach/work?
Have you worked with a sports psychologist/mental coach? If so, briefly describe this experience
What is your level in your sport/ranking?
What are your primary challenges now? Please describe in detail.
How comfortable are you or your child to discuss feelings, thoughts, and behavior?
Please describe how you or your child are best coached in terms of accountability, frequency of reinforcement/contact, level of need for engagement, etc...
On a scale 1-10 how ready are you to begin mental coaching with Jeff Greenwald
What would you consider a successful outcome from working with Jeff?
Phone Number
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Area Code
Phone Number
Investment Range for a THREE-month personal coaching engagement with Jeff Greenwald:
Please Select
$3,000 or less
$3-$5,000
$5,000 or above for highest level of engagement
Why do you believe you or your child would be a good candidate for personal coaching with Jeff?
Why is making this change important to you now?
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