Injury Recovery Survey

Injury Recovery Survey

Welcome to JSA Sport Psychology a proud member of the Catalyst Institute and affiliate with Larsen Sport Medicine and Physical Therapy (LSMPT). We are excited to be working with LSMPT to offer complimentary services to serve your recovery needs. In order to better serve your needs, we’d like to learn a little more about your recovery and how we can help. Please answer the brief 10 question survey below and note that your responses will be kept confidential with JSA Sport Psychology and LSMPT and will not be provided to any third parties. Thanks!

1. Name

2. Age
<1818-2526-4545-60>60

3. Type of injury/condition you are currently being treated for?

4. Have you read any information about the benefits of mental and emotional interventions on injury rehabilitation process?
YesNo

5. Do you ever feel disconnected with teammates, or the athletic group you train/compete with?
YesSometimesI still feel very connectedNo, I still feel connected

6. What's the biggest challenge of your injury recovery thus far?

7. What do you believe will be the biggest challenge in your injury recovery in the future?

8. Do some of the people in your support network (friends, teammates, family, or colleagues) not understand the challenges involved in your recovery?
YesNo

9. How interested would you be in joining an injury recovery group with other people who are going through similar recovery issues?
Very InterestedSomewhat interested - would like more informationNo interest at this time

10. How interested would you be to meet individually with a Sport Psychologist to improve overall well-being, support your recovery, or enhance your performance when you return to competition? (check all that apply)
Interested in meeting about improving overall well-beingInterested in meeting individually about my injury recoveryInterested in learning more about the mental game to improve my performance during competitionSomewhat Interested in at least one of the above, but would like more informationNo interest as this time


If interested in more information, please provide email/phone number and a JSA Sport Psychology representative will contact you within the next week.
Phone

Email


Thank you for completing the survey. Please note that information obtained in this survey will be kept confidential and not be provided to any third parties. The information obtained in this survey will only be used for purposes to coordinate more comprehensive sport psychology services. If you have any questions please don't hesitate to contact us at 651-699-2677 or Janderson@JSAadvising.com.

  • Proud Provider of Services for Athletes in:
  • Premier Sport Psychology
  • 952.835.8513
    7401 Metro Blvd
    Suite 510
    Edina, MN 55439