Mount Si Golf Course Evaluation Form

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Evaluation Form

Contact Information
First Name:
Last Name:

Information Requested
Date
Home Phone
Work Phone
Cell Phone
Email Address
Mailing Address
City
State
Zip
Birth Date
Emergency Contact
Emergency Contact #
How did you hear about me?
Golf History-Prior Experience
Have you ever had lessons before?	Yes No
If yes, from Whom?
Where did you take lessons?
When did you take lessons?
Are there any physical limitations that could affect your ability to swing the golf club?
If yes, what are they?
Playing Ability
Best nine hole score ever
Best 18 hole score
Current Handicap-If any?
Where is your handicap established?
What club do you currently hit from 150 yards?
What are the ball flight tendencies with the full swing?
How do you feel your ball contact is?
What do you feel are the major problems with your game?
What are your goals for your golf game?
Where do you currently practice on your golf game?
How many hours a week (on average) do you currently practice?
How many hours will you be able to spend practicing after lessons?
How do you feel that you learn the best?
General Comments

How would your rate the following areas of your game?
Woods
Long Irons
Middle Irons
Short Irons
Pitching
Chipping
Sand Play
Putting
Course Management

* Bold Fields are Required