| Name: | |
| Phone Number: | |
| Age: | |
| Height: | |
| Handicap: | |
| Average score over 18 holes (past 3 months): | |
| When was the last time you had golf tuition: | |
| What did you work on/change: | |
| What did you like/dislike about your previous tuition: | |
| Which other sports do you play: | |
| Have you any injuries that could affect your swing: | |
| What is your goal for your golf game in the next year: | |
| Is there a particular shot i.e. shank, hook etc which is causing you a problem: | |
| Do you use any swing throughs at present: | |
| How many rounds of golf do you play per month: | |
| How many hours of practice at a range do you do per month: | |
| For each of the catagories below mark yourself from 1-10.
1 = worst possible state
5 = average
10 = perfect
|
| Putting: | |
| Chipping: | |
| Pitching: | |
| Bunker Play: | |
| Lob Shots: | |
| Tee Shots: | |
| Fairway Shots: | |
| Irons 1-6: | |
| Irons 7-sw: | |
| Ball Striking: | |
| Shot Shaping: | |
| Fitness: | |
| Flexibility: | |
| Warm Up Preparation: | |
| Mental Preparation: | |
| Mental State on Course: | |
|