New Client Intake Form

First name

Last name

Email

What is your current handicap?

Where do you primarily play (name of course(s))?

How often do you play?

A few times per month

Once a week

2-3 times per week

4+ times per week

Which members of the FGA team will you be working with?

Steve Foisy

Michel Dubord

Patrick Sébastien

At FGA, we believe in a trilogical approach to the game of golf, focused on its technical, physical, and mental aspects. To help us better serve you, please fill out the following sections to the best of your abilities.

Technical

The technical game is the primary focus of most golfers looking to improve their performance.

Which aspects of the technical game would you most like to improve?

How many hours per week do you dedicate to improving your technical game?

I rarely practice

1 hour per week

2-3 hours per week

4+ hours per week

In your own words, please describe any other aspects of the game you’d like to improve.

Physical

At FGA, we believe in the importance of physical fitness, for golf and life, and want to provide our clients with the help they need to achieve their physical fitness goals.

On a scale of 1-10, how would you rate your current state of physical fitness?

Have you received a TPI physical screening, with FGA or elsewhere?

YES

NO

Please list any physical issues you may be struggling with as it relates to golf or life.

Please list any physical or fitness objectives you would like to achieve in the next 6 months, as they relate to golf or life.

In your own words, please describe anything else you’d like to address as it relates to physical fitness

Mental

Though a relatively new focus for many golfers, at FGA we believe in the importance of the mental game and helping our clients with different methods of mental training.

Please answer the following to the best of your ability.

On a scale of 1-10, how would you rate your current mental game (1 being weak and 10 being strong)?

On a scale of 1-10, how important is the mental game in your opinion?

Do you struggle with stress and anxiety?

YES

NO

Do you believe stress and anxiety affect your game in a negative way?

YES

NO

Many people get frustrated on the golf course. On a scale of 1-10, how does frustration affect your game (1 meaning you never get frustrated, 10 meaning frustration is ruining your game)?

Do you have experience with meditation or breath training?

YES

NO

In your own words, please describe any experience you have with meditation and breath training (negative or positive)

Which of the following mental training strategies have you engaged with:

Please describe any other aspects of the mental game you’d like for us to consider or work on

General

In your own words, please describe anything else about your game you’d like us to know before we work together.