Participant Intake Form

Please provide the most accurate responses possible.

Most questions can be answered with a brief response below the question.

What offering are you participating in?

Consult CallHalf Day PassHalf Day Pass PlusFull Day PassFull Day Pass PlusCoach Tim to You

First Name

Last Name

Dexterity

Right handedLeft handed

1. How long have you been playing golf where your score matters?

2. Do you have any physical restrictions, old injuries, new injuries, Neck, Shoulder, Back, Hip, Knee, Ankle, foot?

3. What is the lowest score you have ever recorded for 18 holes?

4. What is your current goal for your game?

5. How many hours per week can you set aside for practice – not playing?

6. How many hours per week can you set aside for playing on the course?

7. What is your current handicap or average score?

8. Do you play competitive golf? Ex: USGA events, city championships, high school matches, college matches, mini tour events, club events?

When was your last competitive round? (MM/DD/YYYY) or N/A

9. What is your current status?

AmateurProfessional

10. Do you have a predominant shot shape?

YesNo

11. Can you hit that shot on command?

YesNo

12. Do you have a consistent miss?

YesNo

13. Do you practice with structure, intention and attention? Do you use any training aids in any aspect of practice? Alignment aids, video, drills or games? Please describe.

14. Do you play each hole knowing what the next shot means for your score?

YesNo

15. Do you have a consistent Pre-Shot Routine?

YesNo

16. Are you a target aware player or a self aware player?

17. What aspect of your game allows you to play at a high level?

18. What aspect of your game is a barrier to you playing at a high level?

19. Would you describe yourself as an aggressive player or a conservative player?

AggressiveConservative

Please give a brief example of your answer.

20. Would you consider yourself a conventional thinker or creative thinker when approaching areas of improvement in your game?

21. Do you have a role model player, a player you follow closely to utilize a form of remote learning from? Height & build, Tempo, how they conduct themselves on course or with the press.

YesNo

Anything you would like to share with Coach Tim?

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