Sports Psychology—New Client Form 

Parent Name *
Parent Name
Parent Phone *
Parent Phone
Athlete Name *
Athlete Name
Athlete Phone
Athlete Phone
Preferred Communication *
I agree to counseling services at $100 per hour to include Athlete Counseling, Parent Counseling & attending events if needed. Time is prorated. Payment due when services rendered *
I understand that every phone call is pro rated billable time and will make every effort to pay within 24 hours *
Payment Method *
Payment due when services rendered
I understand that the most effective method for my family is athlete meeting, then parent meeting, followed by weekly athlete meetings until goals are met *
I understand that Coach J cannot be held liable for any actions by my child that result in injury, damages, financial and otherwise *