Welcome to the Pre-Lesson questionaire form.  As a new student and through our first few lessons it is very important for me to collect information about your current game, equipment, and what you are trying to achieve before our first lesson.  The more I know before the first lesson the quicker we can get started.  Please complete the questionaire as best you can!

Thank you!

Stacy

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Profile Information

Name:
First:   Last:
Email:
Contact Number:
Occupation:
Height: 5 6 4 1 2 3 4 5 6 7 8 9 10 11
Birthday: Jan Feb March Apr May Jun Jul Aug Sept Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

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Have you had lessons in the past?  If yes, please tell me about them and if possible include your instructor name(s)

Playing Experience?   20+ 10+ 5+ 1-4 years Beginner
Do you play? Right-Handed Left-Handed
Handicap or Average Score:
How many times do you practice per month?  20+  10-19  1-9  Not Applicable
How many rounds do you play per month? 20+  10-19  1-9  Not Applicable

Do you have any current or past injuries to your joints, muscles, back, etc?  If so please list below:

Have you had surgery on any of your joints, muscles, back, etc? If yes please explain below:

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Please identify the equipment that you are currently playing.  If you do not have a set of clubs you can skip this section:

Driver

Brand Model Loft 12 11.5 11 10.5 10 9.5 9 Other
Shaft Flex X-Stiff Stiff Regular Senior Ladies Other Shaft Composition Steel Graphite Fitted? No Yes

Irons

Brand Model
Shaft Flex X-Stiff Stiff Regular Senior Ladies Other Shaft Composition Steel Graphite Fitted? No Yes
Set Make-up Not Applicable 2-PW 3-PW 4-PW 5-PW

Hybrids

Brand Model Loft 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Shaft Flex X-Stiff Stiff Regular Senior Ladies Other Shaft Composition Steel Graphite Fitted? No Yes

Fairway Woods

Brand Model Loft 3-Wood 4-wood 5-wood 7-wood 9-wood
Shaft Flex X-Stiff Stiff Regular Senior Ladies Other Shaft Composition Steel Graphite Fitted? No Yes

Wedges

Brand Loft (Other than Pitching Wedge) Gap Sand Lob 62 60 58 Other
Shaft Flex X-Stiff Stiff Regular Senior Ladies Other Shaft Composition Steel Graphite Fitted? No Yes

Putter

Brand Model Length 32 33 34 35 36 Other   Fitted? No Yes

Proficiencies

How do you feel your proficiency is with the following clubs or shots?

Driver Not Applicable Beginner Good Average Poor
Fairway Woods Not Applicable Beginner Good Average Poor
Hybrids Not Applicable Beginner Good Average Poor
Long Irons Not Applicable Beginner Good Average Poor
Mid Irons Not Applicable Beginner Good Average Poor
Short Irons Not Applicable Beginner Good Average Poor
Wedges Not Applicable Beginner Good Average Poor
Chipping Not Applicable Beginner Good Average Poor
Pitching Not Applicable Beginner Good Average Poor
Bunker Play Not Applicable Beginner Good Average Poor
Putting Not Applicable Beginner Good Average Poor
Uneven Lies Not Applicable Beginner Good Average Poor

When you practice, what size bucket do you typically hit? X-Large Large Medium Small
What is the carry distance of your 7-Iron? 70 110 110 110 110 115 120 125 130 135 140 145 150 155 160 165 170 175 180 185
What is the distance that you hit your driver? Less than 200 yards 200-220 yards 220-240 yards 240-260 yards 260 yards or longer
How often do you exercise? 5x or more per week 4x 3x 2x 1x I don't but plan on it
How would you describe your most common ball flight? Straight Slice Hook Pull Push
How would you describe your trajectory? High Mid Low
When you miss do you typically: Top the ball (Causes the ball to roll along the ground) Hit it fat (hit the ground behind the ball) Hit it thin (hard feel,ball hit low on club face, taking off low and fast) Low left Low Right
The direction of my divots are?  Square (straight) to the target line Left of the target line Right of the target line
The grass marks or tee marks on your clubface appear on the ___? Toe Heel Center
Which of the following best reflects your learning style? I am a visual learner I learn by feel
What other sports are you currently participating in, or have participated in? Football Basketball Track and Field Not Applicable Other
How did you hear about me? Referral Internet Advertising Other
Who referred you?
What do you wish to accomplish by taking lessons and/or what are your goals?


Is there anything else you would like me to know that is not listed in the questionaire?