Name *


email address: *


I am interested in... *
Choose one of the following: 1 Session - $175 US Custom Coaching Package - $449 US Upgrade to Custom Coaching Package - $274 US

Please provide some suggested dates and times for the session(s) and the time zone you are in... *


YOUR GOLF HISTORY... PLEASE BE AS DETAILED AS POSSIBLE TO SAVE TIME FOR INSTRUCTION IN OUR SESSION(S)

How many years golfing?
Just starting out 1st year 2 - 4 years 5 - 10 years 11 + years

If you keep score, what is your best score ever?


What is your normal scoring range?
70 - 79 80 - 89 90 - 99 100 - 109 110 - 119 120 + Does not apply

WHAT TYPES OF INFORMAL INSTRUCTION HAVE YOU HAD? (check all that apply)

Range tips ("Keep your head still" etc...) from family/friends/others

YouTube and/or television instruction

Golf Instruction Videos

Golf Instruction Books and/or Magazines

My own thoughts and experimentation

Have you had formal instruction with a Teaching Professional?
No Yes

IF YOU HAVE HAD FORMAL INSTRUCTION, WHAT TYPE HAVE YOU HAD? (Check all that apply)

Group lessons

Private lessons

A single one off lesson

The odd single lesson now and then

3 to 5 lessons

10 or more lessons

Vacation golf school

Extensive ongoing lessons

In point form, please outline as many key swing thoughts that you have learned from both formal and informal instruction that have stayed with you in your swing development...


Outline what you feel (or have been told by others) are your main swing flaws...


Please provide any other information that you feel is relevant with regard to your experiences with both formal and informal (Professional) instruction...


WHICH OPTION(S) BEST DESCRIBES YOUR LEARNING STYLE? (Check all that apply)

Visual – you learn best through "seeing"

Auditory – you learn best through "hearing"

Kinesthetic – you learn best through "feeling"

Verbal – you learn best by "verbalizing" what you are learning

Do you have any golf related health concerns?
No Yes

If yes, please provide some details (e.g. back or joint problems, arthritic hands, etc.…


THE FOLLOWING INFORMATION IS OPTIONAL BUT RECOMMENDED AS IT GIVES ME INFORMATION TO RELATE TEACHING CONCEPTS TO EXPERIENCES YOU ARE FAMILIAR WITH IN YOUR WORK AND RECREATIONAL LIFE...

Job Title/Field of Work:


Company:


Hobbies and activities: