Neuro Football Athlete Intake Form Basic Info Your Name* Age* Position Team / Club Self-Assessment (1 = Strongly Disagree, 10 = Strongly Agree) I feel confident in my abilities during competition. 1 2 3 4 5 6 7 8 9 10 I stay focused and composed even under pressure. 1 2 3 4 5 6 7 8 9 10 I bounce back quickly from mistakes or setbacks. 1 2 3 4 5 6 7 8 9 10 I enjoy playing and feel motivated to improve. 1 2 3 4 5 6 7 8 9 10 I have strong self-talk that lifts me up during tough moments. 1 2 3 4 5 6 7 8 9 10 I get nervous or anxious before games. 1 2 3 4 5 6 7 8 9 10 I overthink or second-guess my decisions during play. 1 2 3 4 5 6 7 8 9 10 I compare myself to teammates or opponents often. 1 2 3 4 5 6 7 8 9 10 Iām open to learning new tools to strengthen my mindset. 1 2 3 4 5 6 7 8 9 10 Open-Ended Questions When do you feel like you play your best? What are your favorite moments in soccer? When do you feel happiest, freest and most powerful? When do you not play your best? What is the worst feeling you get on the soccer field? What triggers it? What do you feel are the biggest mental challenges holding you back? Are there specific goals or mental blocks you want to overcome? (Short Term & Long Term) Submit Athlete Intake
