GOLF STUDENT INTAKE FORM

Information about you and your game.

Thank You for booking a golf lesson

I’m excited to help you improve your game! Whether you’re brand new or just looking to sharpen your skills, you’re in great hands.

So what’s next?

Now that you have booked your golf lessons. There is one more step that I would like you to do.

Please take a moment to fill out my golf intake form.

FILL OUT THE FORM

Why do I need to fill out the form?

To maximize your time on the lesson tee, please complete our online golf questionnaire before your scheduled appointment.
This crucial pre-lesson step allows me to thoroughly review your game profile. Including your golfing history, specific goals, current challenges, and even any injury considerations— well in advance.
By providing this information upfront, we bypass introductory assessments on the range. Allowing me to be fully prepared with a tailored improvement plan.This ensures we can dive immediately into personalized instruction and swing analysis, spending every valuable minute focusing purely on your game development.

What do I need to bring to the lessons?

For the Indoor Golf Lessons, you will need golf shoes or clean running shoes.
You can bring your entire club set if you like, or you can also just bring:
- a few irons (7 & 9)
- a driver
- a 3 wood or Hybrid
Both indoor and outdoor locations have snacks and beverages

Barry Eisenzimmer Golf Instruction

GOLF INTAKE FORM

CLIENT INFORMATION

Your Name*

Email address*

Phone*

Company

YOUR GOLF HISTORY

What is your Average Score (or Handicap)?*

Enter 0 (zero) if you are just a beginner and haven't been keeping a score when golfing).

How many years have you been playing golf?*

How many rounds (18 holes) do you typically play in a year?*

Do You Normally Play:

18 Holes

9 Holes

Do you play ...*

Right Handed

Left Handed

Are your golf clubs ...*

Custom Fitted

Off the Rack

Combination of both

Have you taken golf lessons before?*

Yes

If Yes, how long ago?

How many lessons?

When playing, do you generally play the same golf course?*

Yes

Contact Email*

YOUR GOLF STATISTICS

Do you keep track of how many putts you have in a round of golf?

Yes

On average, how many putts do you have in a round of 18?

Do you keep track of how many fairways you hit while playing?

Yes

On average, how many fairways do you hit in regulation?

Hitting a fairway in regulation is when you tee off and you ball lands on the fairway with that tee shot.

Do you keep track of how many greens in regulation you hit?

Yes

On average, how many greens do you hit in regulation?

Hitting a fairway in regulation is when you tee off and you ball lands on the fairway with that tee shot.

What is the Strength of your Game?

Select all that apply.

Driving

Fairway/Long Irons

Short Irons

Putting

What is the Weakness of your Game?

Select all that apply.

Driving

Fairway/Long Irons

Short Irons

Putting

GOLF PRACTICE

How often do you practice?*

Do you have a practice routine?

Yes

Do you follow a set up routine before hitting a ball?

Yes

Do you practice with a variety of clubs on different shots?

Yes

Do you practice only 1 club hitting the same shot?

Yes

Is time limiting your ability to practice?

Yes

What do you want to accomplish at the end of a practice session that would improve your swing?

YOUR GOLF GOALS

Have you set goals in the past for golf: *

Yes

Somewhat

Did you achieve your goals:

Yes

Somewhat

What type of goals did you set:

Long Range

Short Range

Practice Goals

Playing Goals

How important is goal setting to the success of your golf improvement:

Very important

Somewhat important

Not very important

Briefly summarize the goals you wanted/did to achieve:

Do you play for:

Select all that apply.

Fun

Score

Both

Regina Golf Blog

Don't have time for lesson?

Check out my golf blog for tips and drills.

READ ARTICLES

REGINA GOLF LESSONS

Learning golf makes your game more enjoyable. Eliminate frustration and disappointment today!

We take great pride in helping our students achieve their goals. Barry provides several golf lessons and clinics.

WHERE CAN I TAKE GOLF LESSONS IN REGINA?

Barry teaches golf to all levels of golfers in Regina.

Junior Golf Lessons Regina
Adult Golf Lessons Regina
Corporate Golf Lessons Regina

WHEN CAN I TAKE GOLF LESSONS?

Golf Lessons are held in Spring, Summer, and Fall at Flowing Springs Golf Greens.

Winter Lessons are taught at Divots Indoor Golf.

CONTACT BARRY

To learn more about Golf Lessons in Regina, call Barry at 306 533 4803 or email Barry.

GOLF GLOSSARY

The golf glossary used on this site is courtesy of the PGA website.