Interested in working together?Fill out some info and we will be in touch shortly! We can't wait to hear from you! Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Person Completing This Form * Player Head Coach Assistant/Associate Coach Parent Scout Agent Other Athlete Age * Sport Played * Football Hockey Wrestling Basketball Golf Volleyball Cross-country Track Softball Baseball Tennis Gymnastics Cheerleading Swimming/Diving Soccer Lacrosse Skiing/Snowboarding Current Team Affiliation - Enter N/A for Independent Athletes (e.g., Golf / Tennis) * Highest Level Played * Link to Player Profile or Personal Website (if applicable) Describe any current challenges you are facing or your reason for seeing out services * Please select the one most applicable to you * I am currently seeing a therapist/counselor/psychologist I have seen a therapist/counselor/psychologist in the bast, but not currently I have never seen a therapist/counselor/psychologist, but am interested in seeing if it would be beneficial for me None of these - N/A Other Comments How did you hear about us? * Thank you! Jen will review your submission and personally reach out to you via email, phone, or text to discuss the next steps.
