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First name
Last name
Email
Phone
Birthday
Month
Day
Year
How long have you played golf for?
Less than 1 year
1-3 years
4-10 years
10+ years
Current Handicap/Average 9 or 18 hole score
How often do you play?
Daily
3-5x/week
1-2x/week
Monthly
Occasionally
How often do you practice?
Daily
3-5x/week
1-2x/week
Monthly
Rarely
What are your top three goals? Why are these goals important?
What does success look like to you in the next 6-12 months?
Current Game Evaluation, score from 1-5, with 5 being the best.
Driver
1
2
3
4
5
Fairway Woods
1
2
3
4
5
Hybrids
1
2
3
4
5
Irons
1
2
3
4
5
Wedges
1
2
3
4
5
Greenside bunkers
1
2
3
4
5
Fairway Bunkers
1
2
3
4
5
Chipping
1
2
3
4
5
Pitching
1
2
3
4
5
Putting
1
2
3
4
5
Course Management
1
2
3
4
5
Mental Game
1
2
3
4
5
Mental Game
1
2
3
4
5
Practice Habits
1
2
3
4
5
Select your top 3 challenges that hold your score back
Inconsistent Contact
Slice
Hooks
Distance
Accuracy
Distance Wedges
Chipping
Pitching
Bunkers
Putting
Mental Game
Course Management
Confidence
Scoring
Typical Ball Flight
Straight
Fade
Slice
Draw
Hook
Typical Miss
Topped
Thin
Fat
Toe
Heel
Push
Pull
Push Hook
Pull Hook
Push Slice
Pull Slice
Short-Game Struggles and preferred wedge
Putting Struggles
Were you professional fitting? Please list your equipment
Physical Assessment: Previous Injuries/Surgeries/Pain/Mobility (please explain):
Previous Instruction
Yes
No
What worked, what didn't
Practice Habits: Please describe what a typical practice session looks like. Where do you practice/spend most of your practice time (i.e., range, short-game area , simulator, etc...)
Typical practice time
Less than 30 minutes
1-hour
2-3 hours
4-6 hours
6+ hours
Where do you lose confidence?
Thoughts before poor shots?
Do you use?
Pre-shot routine
Post-shot routine
Visualization
Breathing
Journaling
None
Learning styles
Wathcing/Visual
Listening
Kinesthetic/Feel
Drills
Technology
What kind of feedback do you prefer
After every swing
After several swings
Ending Summary
Interested in
Practice plans
Long-term improvement
Drills
Tournament Prep
Mental Game Training
On-Course
Other
What is your commitment level to practicing and working on improving you game, score from 1-10, with 10 being the best.
Obstacles to working on your game
Submit
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