Name:___________________________ Date:  __________________   Email: ______________________________________________
Phone:(H)________________(C)_______________
 
You: 
1. Please name any physical challenges you are experiencing within the past 12 months __________________________________________________
2. Please indicate if you have had any surgery within the  past 5 years.  If so, what type?  _________________________________________________
3. What is your home state? ____
4. What is (was) your vocation? ______________________________







Please indicate your learning    style by
answering the following questions:



  1. How do you know when you’ve hit a good shot?  Looks ______ Sounds ______ 
    Feels ______

  2. When you relax, would you be more likely to (a)  
           read a book; (b) take a nap or (c) watch
    tv?

  3. Do you balance your checkbook? 
    Y ____ N ____If so, is it “to the         penny”? 
    Y ____  N
    _____


Your
Golf Game:   Do you play: (1) Executive
courses (2)  Championship Courses (3)
Both


What is your average Score for Executive
Course________   
Championship Course ________   



How often do you play? ________     
How long have you been playing? 
_______



Do you have a handicap? _____ If yes, what is it?
_____


 




Have
you had lessons before?       Yes ____      No ____   If yes, how long ago? 
_____





Your
Golf Goals:  What do you wish/hope to accomplish with  this lesson or lesson
series?  
______________________________________________________________________________________




______________________________________________________________________________________




 


Feedback:  Would you be interested in
participating in  a group lesson? 
Y___ N___





Please
indicate your error tendency with an “X”:





Thin
(topped) _____   Fat(hit behind the ball) _____ Right of
target_____   Left
  of target _____ 








Practice:  Do
you practice:  Yes ___  
  No ___  If yes, how often
do you  practice? 
____x/week



How did you hear about us?   
Referral (Name) __________________________________________ Villages
  Newspaper ___Radio ____________ 
   Other
  _____________________


Please add any other information you think we should know about
your golf
game._________________­­­­­__________________________________________________


Thank you for taking the time to complete this
questionnaire.



Golf Your Best, Inc., Oxford Golf Center, 11247 N
US 301, Oxford, FL  34484,
352-446-2255