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EPEX Mental 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
I am seeking:
Section 2: Sport / Background
Primary Sport or Role (Select all that apply)
If you selected 'Other', please specify:
Level of Competition (Select all that apply)
How did you hear about EPEX Performance? (Select all that apply)
If you selected 'Other', please specify:
Section 3: Mental Performance
What mental or emotional challenges have been impacting your performance recently? (Select all that apply)
If you selected 'Other', please explain:
What does success look like for you in this season? (Select all that apply)
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
Are you interested in combining athletic training with mental performance coaching?
Section 5: Investment & Scheduling
Mental Performance and Combo Coaching: I typically ask for at least a 6-session commitment from new one-on-one clients. These packages range from $300-$500. Does this financial investment reflect your commitment to your goals at this time?
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.
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EPEX Mental Performance Intake Form

Section 1: Basic Information

Section 2: Sport / Background

Section 3: Mental Performance

Section 5: Investment & Scheduling