Golf Questionnaire

First Name*
Last Name*
Email*
How often do you golf?*
- Every day
- Once a week
- 2 to 3 times a week
- Once a month
- 2 to 3 times a month
- Less than once a month
Present Handicap*
Ideal Handicap*
Have you been fitted correctly for your clubs?*
- Yes
- No
Do you work with a golf pro on form?*
- Yes
- No
Do you have any golf related injuries?*
- Yes
- No
Any low back pain on or off the course?*
- Yes
- No
Do you experience discomfort or pain in your backswing?*
- Yes
- No
Do you experience discomfort or pain in your downswing?*
- Yes
- No
Please list any discomfort, pain or golf related injuries along with ant treatment plans you have tried in the past.*
Other Comments / Questions*

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