Self-Evaluation Form
please be honest with your answers
Full Name
Your answer
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Telephone Number
Your answer
Email Address
Your answer
Occupation
Your answer
Present Handicap or Average Score for 18 Holes
Your answer
Best 18 Hole Score
Your answer
How many years have you been playing golf?
Your answer
How often do you play?
Your answer
How often do you practice?
Your answer
Please choose an option from the list below to self-evaluate your putting.
Required
Describe any problem(s) you have with putting.
Your answer
Please choose an option from the list below to self-evaluate your chipping and pitching.
Required
Describe any problem(s) you have with chipping and pitching.
Your answer
Please choose an option from the list below to self-evaluate your bunker play.
Required
Describe any problem(s) you have with bunker play.
Your answer
Please choose an option from the list below to self-evaluate your full swing with your irons.
Required
Describe any problem(s) you have with your full swing with your irons.
Your answer
Please choose an option from the list below to self-evaluate your full swing with your woods.
Required
Describe any problem(s) you have with your full swing with your woods.
Your answer
Please choose an option from the list below to self-evaluate your physical condition.
Required
Please list any physical problems that would influence performance.
Your answer
Please choose an option from the list below to self-evaluate your psychological control on the golf course.
Required
Player's statement of what he/she wishes to accomplish through a series of golf lessons.
Your answer
Your ultimate goal you'd like to achieve.
Your answer
The date by which you'd like to achieve your goal.
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