Intake Form

Please fill out our intake form below

Name:
Email:
Phone:
Current Status:
If Retired, how long have you been out of the game?
Last Pro League:
Level of Education:
If you have post-secondary education, please specify program:
Relationship:
Work Experience:

Interests outside of hockey:

Dream Job:
Preferred City for Retirement:
Any other services that might be important to you: (Mental Health, Concussion, Substance Abuse, Education, Finance, Etc.)



All forms will be kept confidential and shared only with people involved in the After the Game program and only with the client’s permission.