Mental Game Pre-Program Questionnaire Question Title * 1. What is your child's full name and email address? Question Title * 2. What is your age? 17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older Question Title * 3. Please rank what topics are most important to you now 1 2 3 4 5 6 Focus 1 2 3 4 5 6 Confidence 1 2 3 4 5 6 Negative Thinking/Over-Thinking 1 2 3 4 5 6 Anger/Overly Emotional 1 2 3 4 5 6 Nerves/Tentative Play 1 2 3 4 5 6 Stress/Pre-event nerves Question Title * 4. If you had one wish for this mental skills coaching in terms of outcome what would it be? Question Title * 5. Explain why you are coachable. Please provide an example Question Title * 6. How much time per week are you prepared to invest in mental skills? 30 minutes per week 1 hour per week up to two hours per week Question Title * 7. Why do you think the mental game is important? Describe how improvement in this area has helped you in the past Question Title * 8. Is there an area in your life that you'd like to improve outside of your sports performance? Describe how this issue might also show up for you in competition. Question Title * 9. Please describe in detail a time when you didn't perform to your ability Done. Thank you! To contact Jeff directly email: jeff@mentaledge.net ph: 415-640-6928