Raise Your Game

The form below is part of your initial intake.
Your coach will contact you and use this information as a foundation to provide the best program for you to achieve your goals. Once submitted, you will be contacted by a coach to schedule your intake consultation.

"*" indicates required fields


Date Of Birth




Do you have a history of any of the following medical conditions?

Please rate your pain in each area on a scale of 0 ( no pain ) to 10 ( worst pain possible):


Please rate your current goals from 1( most important) to 8 (least important):

Performance Questionnaire

If you play or participate in any competitive sports please fill out the information below.


"I hereby understand and acknowledge that this waiver includes any training, programs, dietary recommendations, supplement recommendations, any and all recommendations, any and all advice, any and all referrals, as well as any events or participation in any activity outside of the Neuro Force One (NF1), a Delaware C-corporation, facility. Such activities may expose me to many inherent risks, including accidents, injury, illness, or even death. I assume all risk of injuries associated with participation including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity and all other such risks being known and appreciated by me.
I hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in activity. I acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in. After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and NF1 furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE NF1, its officers, agents, employees, organizers, representatives, and successors from any responsibility, liabilities, demands, or claims of any kind arising out of my participation in NF1 training, programs, assessments, dietary recommendations, supplementation recommendations, any and all recommendations, any and all advice, any and all referrals, and/or events. By my signature I indicate that I have read and understand this Waiver of Liability. I am aware that this is a waiver and a release of liability and I voluntarily agree to its terms."

(Parent's Signature if under 18 years of age) I represent that I have legal capacity and authority to act on behalf of the minor named herein.

I agree to the terms and conditions.*
This field is for validation purposes and should be left unchanged.