Name: _______________________________________________ Phone Number: __________________ Mobile: _________________

Email Address: ___________________________________________

Mailing Address: __________________________________________ CITY______________________ ZIP_____________

How long have you played golf? _____________

What is your Present Index? _____________

What is your home course? ___________________

Are you Right or Left handed? R L Do you play Right or Left? R L

Do you have any physical limitations? Y N If so, please describe: ______

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How, why, and where did you start playing? __________________________

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What is your favorite golf memory? __________________________________

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Describe your best golf performance: ________________________________

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Best round (and where) in the last 30 days __________________________

Which part of your game comes easiest to you? _______________________

What is the weakest part of your game? ______________________________

John P Klein Golf Student Questionnaire

1

Have you taken golf lessons before? Y N

From Whom? __________________________________________________

Most Recent Coach? _____________________________

For how long? __________ What were you working on? _______________

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How much time do you devote to game development weekly (hours per week;

please breakdown by on-course versus practice time)? _________________

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Describe a typical practice session: __________________________________

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Do you normally warm-up prior to playing/practicing? Y N

If so, what do you do? ___________________________________________

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How would you describe your physical condition? ______________________

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John P Klein Golf Student Questionnaire

2

Which tour professional do you like the most and why? __________________

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Do you have written goals for your game? Y N

Describe your goals for your game: _________________________________

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What do you hope I can help you with? ______________________________

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Dated: ________________________

Signed: ____________________________________________

Please scan and email to john@johnpklein or fax to 888.792.4659

Thanks! I look forward to meeting with you. John

John P Klein Golf Student Questionnaire

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