Coaching golfers to their BEST Game!
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IMPACT AWARE™ Golf
Dr. Eric C. Wilson
Ken Martin
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Initial Student Interview
Please complete the items below prior to your lesson. Thank you.
Following are some areas to consider when completing the form:
Full Swing/Ball Striking
Partial Wedges
Pitching
Chipping
Putting
Bunker Play
Game Management on the Course
Mental Game
Practice Schedule/Routine
Consistency
Ability to Score/Reduce Handicap
Play Competitively
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Indicates required field
Name
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First
Last
Phone Number
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Email
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Occupation/Hobbies:
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How long have you been playing golf?
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Lowest Score:
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How many times do you play golf each week?
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How many days do you practice golf each week:
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What injuries or pains do you have that affect your game?
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What Ball Flight Pattern would you like?
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What is your present Ball Flight Pattern with your irons?
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Do you hit the ball too high or too low with your irons?
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Describe what you think are the major problems in your golf game:
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Tell me what you have tried to fix these problems:
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What is the best part of your game?
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What other sports have you played?
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What is your goal for this lesson or series of lessons?
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Handicap:
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Handicap Goal:
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Do you write or throw right or left handed?
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Right Handed
Left Handed
Do you play golf right or left handed?
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Right Handed
Left Handed
What is your present Ball Flight Pattern with your driver?
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Do you hit the ball too high or too low with your driver?
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What Ball Flight Pattern would you like?
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What is your best club?
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What is your worst club?
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Tell me about your most recent lessons/golf schools attended:
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How did you hear about Impact Aware Golf?
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Internet Search
Postcard
Brochure
Referral
Other
If Referral, please provide name:
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If Other, please specify:
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Submit