Clone of EPEX Performance

EPEX Athletic 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:*

Mental Performance CoachingAthletic Performance CoachingI may be interested in a combination package
Section 2: Sport / Background
Primary Sport or Role (Select all that apply)*

Bareback RidingSaddle Bronc RidingBull RidingTie-Down RopingSteer WrestlingTeam RopingBreakaway RopingBarrel RacingGoat TyingEquestrianFootballBaseball / SoftballBasketballTrack & FieldWrestlingSoccerTennisBusiness OwnerExecutive / LeaderCoachSales ProfessionalOther
If you selected 'Other', please specify:
Level of Competition (Select all that apply)*

Junior HighHigh SchoolCollegiateAmateurProfessionalNot Applicable
How did you hear about EPEX Performance? (Select all that apply)

Social MediaFriend or FamilyCoachGym / Training FacilityEvent / ClinicOther
If you selected 'Other', please specify:
Athletic Performance
What are your current physical performance goals? (Select all that apply)

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
What areas of your physical performance need the most improvement right now? (Select all that apply)

StrengthPowerSpeedConditioningMobility / flexibilityBalance / coordinationCore strengthRecovery habitsOther
Current Training Routine
Access to Equipment

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
How many days per week can you realistically commit to training?

2–3 days3–4 days4–5 days5+ days
Are you interested in combining athletic training with mental performance coaching?

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
How committed do you currently feel about taking your physical performance to the next level?*

Yes, I’m ready to commitPossibly — I’d like to learn more or explore other optionsNot at this time, but maybe soon
Time Zone & Availability: Please include your time zone and general availability
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 Athletic Performance Intake Form

Section 1: Basic Information

Section 2: Sport / Background

Athletic Performance

Section 5: Investment & Scheduling