UNBREAKABLE YOU. Mastermind Application
This application is designed to get to know you, your current challenges with a sports injury, your goals, and the type of support you're looking for to rock the rest of your recovery process and beyond. I want to make sure this container is the right fit for your needs, so please answer all questions with 100% honesty. There is no "wrong" answer! In this container, we understand that the REAL YOU is the BEST YOU!
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Email *
What is your email address? *
Basic Demographic Information
Full Name *
Preferred Name (if different from above)
Birthday *
MM
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DD
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YYYY
Current Home Address *
What is your t-shirt size? (women's fit -- if looking for men's fit or unisex, size up!) *
Who lives with you at home? *
How were you connected with/referred to me? *
If a healthcare provider referred you, I'd love to thank you them! Who sent you my way? *
Getting to Know Your Injury and Your Story
What is your injury and when did it happen? *
What sport(s) do you play? *
In one sentence, what is your biggest struggle related to your injury/recovery process? *
What is your big picture goal that you want to achieve with the help of the support and tools you have access to in this mastermind? *
What type of support do you want/think you need in order to reach that goal? *
Job/Career 
What is your job/career *
What is your annual household income? *
How fulfilled are you in your job/career *
Totally Unfulfilled
Totally Fulfilled
How is your injury impacting your job/career? *
What do you like to do for fun? *
What important events/happenings (if any) do you have coming up in the future? *
Lifestyle
On average, how many hours per night are you sleeping? *
If you're having trouble sleeping, what's keeping you up at night? *
How many days a week are you participating in some sort of mindfulness practice? (prayer, journaling, meditation, breathing, drawing/coloring, cooking, etc.) *
If you do participate in a mindfulness practice, what is your go-to activity? *
How many days per week are you participating in some sort of movement practice? *
What type of movement/exercise do you currently practice? (Please include what you did before injury and currently if there is a difference). *
A Day In The Life
How stressed, overwhelmed, upset, fearful, or angry are you feeling in your rehab process? *
Not at all
The maximum amount
What is the dominant emotion you are feeling in your current situation? (If you don't know, that's an okay answer too!) *
How is this life situation affecting the other aspects of your life? (relationships, job, productivity, friendships, etc.) *
On an average day, how do you feel overall? *
On an average day, do you tend to feel more positive and ready for action most of the time or more negative and stuck? *
Negative/Stuck
Positive/Ready to take action
How is your energy? Consider your tiredness, sluggishness, ability to calm down at night, how you feel when you wake up, how you feel at work, school or while you exercise) *
Completely Empty
Completely Full
How you feel about your role as a student or as an employee of a job? (Consider meeting your/others expectations, goal setting, taking action, procrastination, not feeling good enough) *
Completely Empty
Completely Full
How do you feel about your relationships with others? (Consider family, friends, loves ones, romantic partners if applicable) *
Completely Empty
Completely Full
How stress-free is your life generally? Consider time on the go, doing projects, wondering what others will think about your work/role, how often you’re thinking of and plotting a to-do list, maintaining attention on one task at a time, how much down time is in your day, ability to set boundaries and say no when you really want to say no, amount of vacation/time off.
 *
Completely Stressed-Out
Completely Stress-Free
How much fun and joy is in your life? Consider play, creativity, travel or whatever else you find fun.
 *
Completely Empty
Completely Full
Choose the answer that most accurately reflects the level of impact this injury has on your mental health. *
No impact at all
My mental health has completely tanked
Choose the answer that most accurately reflects the level of impact this injury has on your ability to focus at work. *
I am focused 100% of the time
I am unable to focus at all
Choose the answer that most accurately reflects the level of impact this injury has on your body image. *
No impact at all
I 100% hate the way my body looks and feels
Do you have a history of clinically diagnosed disordered eating behaviors? *
If you do have a history of clinically diagnosed disordered eating behaviors, have you/are you work(ing) with a licensed psychologist? *
What is your preferred learning style? *
I MOST often tend to be...
 *
How willing are you to take ownership of the way you experience life and commit to doing the work that will create the results you desire?
 *
Completely Resistant
Totally on board. You say jump, I'll ask, "How high?"
If you are not a "10" on the scale above, what's holding you back form being a 10? *
How willing are you to take direction on things you can do to benefit your mindset?
 *
Completely Resistant
Totally on board. You say jump, I'll ask, "How high?"
If you are not a "10" on the scale above, what's holding you back form being a 10? *
What barriers do you anticipate may get in the way of you making changes?
 *
Describe who is involved in your personal support system. Examples: spouse, clergy, friend, coworker, significant other, children, parents, etc.)
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Describe what “getting better” looks like for you and how you will know when you get there?
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Choose the answer that feels MOST true to you.
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Finish this sentence: Right now I….
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The investment for experiencing the powerful results associated with support from Jen Davis Coaching starts at $3000 with payment plans available. Choose the answer that sounds most accurate for you. (If you're applying in a timeframe where a promotion had been advertised, your investment is the advertised price and payment plans are still available).
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What will it cost you if you do not invest in support around the mental game during your recovery process and beyond?
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What will you gain by investing in support around the mental game during your recovery process and beyond?
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The UNBREAKABLE YOU. Mastermind
The UNBREAKABLE YOU. Mastermind is a group coaching container designed to help you generate the best results possible WHEN you are actively participate in conversation in both the Facebook Group and Group Coaching Calls. Choose the answer that is most accurate for you. *
Inside the The UNBREAKABLE YOU. Mastermind we talk a lot about uncomfortable thoughts and feelings. How committed are you to stepping into vulnerability and being real about your situation? Choose the answer that is most accurate for you.
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Anything Else?
Thanks for the input! What other questions/comments do you have for me that have not been addressed yet?
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