The Golf Club Doctor
146 Twin Arch Rd.
Washingtonville, NY 10992
Phone: (845) 496-5185
FAX: (845) 496-3049
e-Mail: golfclubdoc@hotmail.com

Let me determine your customized golf club specifications. Within 5 days, I'll contact you via FAX, US Mail or e-mail, with my recommended specifications - at no obligation! My recommendations are based on the data you provide. I will calculate your fitting specifications to include some or all of the following:
1. Club model and set make-up
2. Shaft type, length and flex
3. Grip size
4. Swingweight
5. Face angle

I will also provide a price for the recommended set or individual clubs as per your request. Please fill out this form completely for best results.

1. When you hit a poor drive, do you have a tendency to:
Don't know
Sky it
Hit it very low
Pull it
Hook it
Push it
Slice it
Hit straight but not solid
Be very inconsistent
Top it

2. What is your confidence level with your driver?
Very confident
Have confidence
Some confidence
No confidence

3. Circle the distance that best describes how far your average drive carries (no roll included).
Up to 135 yards
Range of 136-170 yards
Range of 171-210 yards
Range of 211-245 yards
Over 246 yards

4. When you hit a poor iron shot, do you have a tendency to:
Don't know
Sky it
Hit it very low
Pull it
Hook it
Push it
Slice it
Hit straight but not solid
Be very inconsistent
Top it

5. What is the longest iron you hit with confidence?
#1 iron
#2 iron
#3 iron
#4 iron
#5 iron
Don't know

6. On which part of the club face do you tend to hit the ball?
Heel
Toe
Center

7. Circle the descriptor that best describes the direction you tend to hit both woods and irons:
Slice
Push
Straight
Pull
Hook

8. Your golf glove size:
Small
Medium
Medium-Large
Large
Cadet Medium
Cadet Medium-Large
Cadet Large

9. I want to: (Please check as many as you like but only if you feel you have a problem in that area.)
Hit the ball higher
Hit the ball lower
Stop slicing the ball
Stop pushing the ball
Stop hooking the ball
Stop pulling the ball
Hit the ball straighter
Hit the ball longer

10. What shaft material do you prefer?
Graphite
Steel
Other (please indicate) ________________________

11. What golf club model(s) are you currently using? (If none, just leave blank)
Driver, __________________
Fairway Woods, _________________________
Irons, _____________________________
Wedges, __________________________
Shaft flex (if known): L, A, R, S, X, Don't Know

12. What club do you use to hit the ball 150 yards?
#1 Iron
#2 Iron
#3 Iron
#4 Iron
#5 Iron
#6 Iron
#7 Iron
#8 Iron
#9 Iron
Other ________________________

13. During the Golf Season, how many rounds of golf do you play per week? ___________
14. Are you: Male, Female
15. Age: _____
16. Weight: _____
17. Height: Feet____, Inches _____
18. Distance to Ground from tip of middle finger (in inches): Right Hand______, Left Hand______
19. I am: Right Handed, Left Handed
20. How many years have you been playing golf: _____
21. Current handicap: (If you don't know just leave blank): ________
22. Is your handicap going up or down? _____
23. What is your average score (18 holes)? ______
24. First name: _________________, Last Name___________________
25. Your Address ________________________________
________________________________
________________________________
26. Your daytime phone (if we have a problem): ________________________
27. Your email address: ___________________________________
28. Your fax number: ___________________________
29. Would you prefer to receive your free fitting by e-Mail, FAX, or US Mail?
E-Mail
Fax
Mail

Additional Information: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________