Number of times you play or practice golf per
month: ___________For the past year - Average score: _____________;
Best Score: ____________ Worst Score: _________Number of times you exercise each week:
___________Type and length of Exercise: Why are you taking this golf lesson (Goals) ? Why do you play golf? (Or if you are just
beginning to play golf, why are you planning to start playing golf? What are your goals for the next month, season,
year, next several years for your golf game? Your favorite professional golfer(s)? Please rate yourself with a 5 being excellent, 4
being good, 3 being average, 2 being below average and 1 being poor in
each of the following areas:
Use an X or Checkmark in the correct
column.5 4 3 2 1
Strength: 5 4 3 2 1
Flexibility: 5 4 3 2 1
Hand-Eye Coordination: 5 4 3 2 1
Physical Stamina: 5 4 3 2 1
Eyesight: 5 4 3 2 1
Touch and Feel: 5 4 3 2 1
Your Commitment to Improve: 5 4 3 2 1
Ability to devote some time to golf: 5
4 3 2 1
How well you know the rules of golf: 5
4 3 2 1
Describe any physical limitations: Describe your golf game in general terms: How many years /months have played the game: Number of golf lessons you have had, when, from
whom and what did you work on during the lesson, what did you learn, how
satisfied or dissatisfied were you with the lesson/lessons, did you
improve, what did you like or not like about the lessons, Strengths in your golf game:Weaknesses in your golf game: Best golf instruction tip you ever received: Biggest “miss” or shot(s) that either you are very
bad at or types of shots that cost you the most strokes during a round:The biggest source of frustration with your golf
game: Average driving distance:____; Average Number of
Greens Hit Per Round: ___; Average number of fairways you hit per round:
_____; Average Number of Putts Per Round: Do you get nervous when you play golf? If yes,
please describe what types of shots or situations make you nervous when
you play golf. Do you get very angry on the golf course? If so,
please describe what types of shots or situations make you very angry when
you play golf. Describe your personality: What golf books, magazines, websites, videos have
you read or viewed recently: Please rate your golf abilities with a 5 being excellent, 4 being
good, 3 being average, 2 being below average and 1 being poor in each of
the following areas: Use an X or Checkmark in the correct column. 5 4 3 2
1
Putting: 5 4 3 2 1
Chipping: 5 4 3 2 1
Full wedge: 5 4 3 2 1
Short Irons Approaches: 5 4 3 2 1
Middle Irons: 5 4 3 2 1
Long Irons: 5 4 3 2 1
Hybrids: 5 4 3 2 1
Fairway Woods: 5 4 3 2 1
Driver: 5 4 3 2 1
Green side bunker play: 5 4 3 2 1
Long bunker play: 5 4 3 2 1
Ability to draw the ball: 5 4 3 2 1
Ability to fade the ball: 5 4 3 2 1
Ability to hit the ball straight: 5 4
3 2 1
Ability to hit ball very low: 5 4 3 2
1
Ability to hit ball very high: 5 4 3 2
1
Your grip: 5 4 3 2 1
Your stance and posture: 5 4 3 2 1
Your ball position: 5 4 3 2 1
Your on-course management: 5 4 3 2 1
Your Temperament: 5 4 3 2 1
Ability to play competitive golf: 5 4
3 2 1
Ability to play under pressure: 5 4 3
2 1
Ability to read greens: 5 4 3 2 1
Your confidence level playing golf: 5
4 3 2 1
What kinds of golf courses do you usually play? What kind of golf clubs do you use? What is your annual budget for golf? How did you buy your golf clubs? Have you ever been fitted for clubs? If so, where and when: Describe what you believe are your biggest challenges or barriers to
improving your golf game and your golf scores: Do other members of your
family play golf and if so, who? Is there anything else you would like the golf instructor to know
about you or your golf game?
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