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* 1. What is your name? If you chose to remain anonymous please provide your pronouns and preferred name.

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* 2. Please list your sport(s) and highest level of competition.

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* 3. How old are you?

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* 4. What city and state do you live in?

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* 5. What is your preferred telephone number and E-mail address?

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* 6. What is your sport psychology problem, issue or concern?

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* 7. Have you worked with a sport psychologist or psychologist before? If yes, please explain.

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* 8. Have you sustained any injuries in your sport(s)? Please explain.

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* 9. Have you ever been hospitalized for mental health reasons? Please explain.

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