Dynamic Golf Institute

First Name:

Last Name:

Address:

Email:

Home Phone:

Business Phone:

Cell Phone:

Occupation:

Home Golf Course:

I've played for:

0 Years Less than 1 year 1-2 Years 2-5 Years 5-10 Years 10+ Years

I have an USGA Handicap:

No Yes

Handicap Index is:

My career low round is:

My competitive experience:

Have never competed Currently competing Would like to

Rounds played each year:

Less than 5 5-10 11-15 16-20 21-30 31-50 51-75 76-100 101-150 150+

Hours of practice (weekly):

Less than 1 1 2 3-5 5-7 7-10 10+

I enjoy practicing:

No Yes

I practice during off-season:

No Yes

I arrive early to golf course:

No Yes

Typical ball flight is:

Straight Draw Fade Pull Push Slice Pull hook Pull slice Push hook Push slice

Typical mis-hit is a:

Hit behind Hook Shank Slice Thin Top

Current instructor is:

Currently working with instructor on my game and I'm primarily interested in golf performance fitness training:

No Yes

At D.G.I., we want to fully understand your golf game which means we need to know what your body is used to, and if you have suffered any injuries.

Number of workouts in a week:

My workouts consist of:

Cardio training Strength training Flexability work Cardio & strength training Cardio & flexability training Strength & flexability training Cardio, strength & flexability training

I stretch regularly:

No Yes

My workout is golf specific:

No Yes

I've had golf related injuries:

No Yes

Describe current & past injuries:

Other sports I've played:

At D.G.I. we are dedicated to helping our clients achieve their goals. Please give this section some thought and be specific with your answers.

I mostly play golf for:

Business Competition Family time Fun Outings Social recreation

I believe my practice habits:

Don't affect my game Help my game Hurt my game

To improve, I can change my habits:

No Yes

In the end, my score:

Does not matter to me Not too important to me Pretty important to me The only thing that matters to me Very important to me

I want regular reminders of the goals I have set and want someone to push me to reach these goals:

No Yes

I regularly set goals:

No Yes

I would be happy to lower my handicap in 1 year by:

1 stroke 2 strokes 3 strokes 4 strokes 5 strokes 6 strokes 7 strokes 8-10 strokes 11-15 strokes 15+ strokes Lowering my score is not the reason I train

I best learn by:

Auditory Kinestetic (feel) Visual Auditory and kinestetic Visual and kinestetic Visual and auditory Visual, auditory and kinestetic Not sure

I want to improve so I can play:

Business golf College golf Local amateur golf Local junior golf More golf National amateur golf National junior golf Professional golf

Rate each area of your game where 1=strength and 5=weakness:

Driving:

1 2 3 4 5

Fairway wood or hybrids:

1 2 3 4 5

Long irons:

1 2 3 4 5

Short irons:

1 2 3 4 5

Wedges (20-80yds):

1 2 3 4 5

Chip/pitch shots (under 20yds):

1 2 3 4 5

Long putts (over 15ft):

1 2 3 4 5

Short putts (under 15ft):

1 2 3 4 5

Course management:

1 2 3 4 5

Pre-shot routine:

1 2 3 4 5

Please describe your golfing goals and what you want to achieve working with DGI. Be specific and help us understand where you want to be short term (within six months), mid term (1-2 years), and long term (3-5 years).: