Know No Limits, Inc.
Client Information Form
For more information about KNL fillout the form below and submit.
Name:
Date:
Date of Birth:
Hometown:
City :
State:
Sport
:
Race/Ethnicity:
Address
:
Contact:
Home Phone :
Cell Phone:
E-mail:
Do you:
Go to School?
Yes
No
If yes, where?
Year:
Major:
Work?
Yes
No
If yes, where?
Job title:
Who referred you to Sport Psychology?
myself
family
trainer
friend
saw/heard about it
other:
teammate
coach
Living Situations
alone
with family
with spouse/partner
with roomates
Sport Psychology History
Have you ever included sport psychology techniques into your sport preparation?
Yes
No
Have you worked with a sport psychologist or a consultant who aided you with mental training before?
Yes
No
If yes, please explain:
Please describe briefly any problems you may have or had regarding your sport:
Please describe your background in the sport of concern:
Please discuss any additional issues that need to be addressed:
