Neuro Football Parent Intake Form Player & Parent Info Parent Name* Player Name* Player's Age* Sport(s) Team / Coach (if applicable) How long have they been competing? Self-Assessment (1 = Strongly Disagree, 10 = Strongly Agree) My child is highly motivated and self-driven. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They handle pressure and criticism well. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They tend to be hard on themselves after mistakes. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 My child seems confident in their sport. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They bounce back quickly from poor performances. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They enjoy their sport and look forward to training/games. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They worry about disappointing others (coach/parent/teammates). Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They compare themselves to others frequently. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 They’ve expressed doubts or fears about their performance. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 I believe mental training could help them grow and enjoy their sport more. Strongly DisagreeStrongly Agree 1 2 3 4 5 6 7 8 9 10 Open Response What are you hoping this program will help your child with? Are there any specific struggles or patterns you’ve noticed? What’s one thing you’d love to see your child gain from this experience? Submit Parent Intake
