EPEX Performance – Intake Form

EPEX Performance – Intake Form

Please take 5 minutes to provide your basic info, background, challenges, and commitment level to getting started.
Section 1: Basic Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Age*
Mental Performance CoachingAthletic Performance CoachingI may be interested in a combination package
Section 2: Sport / Background
Bareback RidingSaddle Bronc RidingBull RidingTie-Down RopingSteer WrestlingTeam RopingBreakaway RopingBarrel RacingGoat TyingEquestrianFootballBaseball / SoftballBasketballTrack & FieldWrestlingSoccerBusiness OwnerExecutive / LeaderCoachSales ProfessionalOther
If you selected 'Other', please specify:
Junior HighHigh SchoolCollegiateAmateurProfessionalNot Applicable
Social MediaFriend or FamilyCoachGym / Training FacilityEvent / ClinicOther
If you selected 'Other', please specify:
Section 3: Mental Performance

SKIP to section 4 if ONLY seeking athletic performance
Competition nerves or anxietyFear of making mistakesOverthinkingHesitation or second-guessingLack of confidencePressure in big momentsDifficulty finishingFrustration or angerTrouble moving on from mistakesOther
If you selected 'Other', please explain:
More consistent performancesStronger confidence in competitionCompeting with less stress or anxietyTrusting my preparationIncreased discipline and focusBreaking through mental barriersImproved results / earningsEnjoying competition againOther
If you selected 'Other', please explain:
When do you find pressure or stress affecting you the most?
Have you ever tried to improve your mental performance? Did you see differences?(Examples: journaling, visualization, coaching, routines, etc.)
Why do you feel lead to seek mental performance coaching?
On a scale of 1–5, how committed are you to doing the work required to reach your goals?

1

2

3

4

5

1 is Not committed, 5 is Fully committed
Section 4: Athletic Performance

SKIP to section 5 if ONLY seeking mental performance
Increase overall strengthImprove power / explosivenessImprove sport-specific performancePre-performance routineImprove speed and agilityBuild muscle / improve physiqueLose body fatImprove conditioning / enduranceEnhance mobility and flexibilityInjury preventionReturn from injuryOther
StrengthPowerSpeedConditioningMobility / flexibilityBalance / coordinationCore strengthRecovery habitsOther
Current Training Routine
Full gym accessLimited equipment (dumbbells, bands, etc.)Home gymTurf / field spaceRodeo practice facilitiesNo consistent accessOther
Injury History or Limitations
How would you rate your current physical fitness level?

1

2

3

4

5

1 is Very low, 5 is Elite
2–3 days3–4 days4–5 days5+ days
Yes — I want bothMaybe — I’d like to learn moreNo — Athletic performance only
What would a “breakthrough” look like for you physically in the next 3–6 months?
Section 5: Investment & Scheduling
Yes, I’m ready to commitPossibly — I’d like to learn more or explore other options (groups, resources, etc.)Not at this time, but maybe soonAthletic Performance ONLY (above packages not included)
Time Zone & Availability: Please include your time zone and general availability for sessions.
Is there anything else you would like me to know before our consultation call?
Thank you for taking the time to complete this form. Please expect to recieve an email for scheduling our discovery call in the next 1-2 business days. I’m looking forward to learning more about your goals and seeing if EPEX Performance is the right fit for you.
Should be Empty:

EPEX Performance – Intake Form

Section 1: Basic Information

Section 2: Sport / Background

Section 3: Mental Performance

Section 4: Athletic Performance

Section 5: Investment & Scheduling