SQUARE1 360™ Golf Assessment

1
Full Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Mobile Phone Number* This field is required.
Please enter a valid phone number.
4
Do you have any physical limiting factors or old or new injuries?* This field is required.
Yes
No
5
Please describe any physical limiting factors or injuries.
6
Age
7
Dominant Hand* This field is required.
Right
Left
8
Current Handicap
9
Average Score
10
Practice Hours Per Week* This field is required.
Please Select
Please Select
We talkin’ about practice…?
Less than 1
1-2
3-5
5-10
10+
11
How did you hear about SQUARE1 Golf?* This field is required.
Beta Test Invitation
Friend or Family Referral
Swing365
Driving Range
Golf Course
Business Card
Flyer / Postcard
QR Code
Facebook
Instagram
Google Search
Email
Local Event / Tournament
Other
12
Target Handicap
13
What is your biggest frustration in golf?* This field is required.
14
How serious are you about improving your game over the next 90 days?
Just curious about my results
Looking for a few tips
Ready to follow a practice plan
Interested in coaching if it’s a good fit
Actively looking for a coach
15
Have you taken golf lessons in the past 12 months?
Yes
No
16
Face-On Swing Video
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Upload a File
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17
Down-The-Line Swing Video
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Select files to upload
Max. file size: 10.0MB
Upload a File
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18
Chipping/Putting Videos
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Select files to upload
Max. file size: 10.0MB
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19
Additional Swing Videos
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Max. file size: 10.0MB
Upload a File
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20
Launch Monitor Data
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Max. file size: 10.0MB
Upload a File
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21
Scorecards
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Select files to upload
Max. file size: 10.0MB
Upload a File
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22
Driver Brand and Model
23
Driver Shaft
24
Iron Set
25
Wedge Setup
26
Putter
27
Golf Ball
28
Equipment Photos*Not required
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Upload a File
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29
🏌️ What’s Your One Thing?* This field is required.What’s REALLY holding you back from reaching your potential in golf? Select the answer that feels most like you.
I don’t know what to work on.
I know what to work on, but I don’t do it.
I don’t have enough time to practice.
I practice, but I’m not getting better.
I get in my own head on the course.
I lose confidence after one bad hole.
My swing changes every round.
I hit great shots and terrible ones.
My short game is costing me strokes.
My putting drives me crazy.
I keep buying equipment instead of fixing the problem.
I don’t trust my game under pressure.
I’m tired of shooting the same scores.
I’m honestly getting frustrated enough to quit.
Other
Other
30
Please tell us what’s holding you back.
31
Image Field
Should be Empty: