Preliminary Questionnaire

1. The Basics

17% of survey complete.

Note: This is a multiple-page survey. At the bottom of each page is a button marked "Next". Please click this button to move to the next page.

The information you provide will better assist me/ us in providing you with a much more personalized and enjoyable experience and will enable me / us to tailor your quality session to your own individual needs and experiences.

Thank you for taking the time to provide this valuable information.

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* 1. Name

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* 2. email address

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* 3. Telephone (area code) 123-4567

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* 4. telephone

home

work

cell

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* 5. best time to call

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* 6. date of birth

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* 7. height

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* 8. weight

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* 9. occupation

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* 10. city in which you are requesting a session or attending a workshop

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* 11. Preferred days / times for your session

	Morning	Afternoon	Evening	Late Night	Any
Any	Any Morning	Any Afternoon	Any Evening	Any Late Night	Any Any
Sunday	Sunday Morning	Sunday Afternoon	Sunday Evening	Sunday Late Night	Sunday Any
Monday	Monday Morning	Monday Afternoon	Monday Evening	Monday Late Night	Monday Any
Tuesday	Tuesday Morning	Tuesday Afternoon	Tuesday Evening	Tuesday Late Night	Tuesday Any
Wednesday	Wednesday Morning	Wednesday Afternoon	Wednesday Evening	Wednesday Late Night	Wednesday Any
Thursday	Thursday Morning	Thursday Afternoon	Thursday Evening	Thursday Late Night	Thursday Any
Friday	Friday Morning	Friday Afternoon	Friday Evening	Friday Late Night	Friday Any
Saturday	Saturday Morning	Saturday Afternoon	Saturday Evening	Saturday Late Night	Saturday Any

Other (please specify)

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* 12. Length of session requested

INTRO (1 hr)

BASIC (1 1/2 hrs)

EXTENDED (2 hrs)

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* 13. type of session requested

1-on-1 (2-handed)

2-on-1 (4-handed)

either

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* 14. if 1-on-1 (2-handed) session, do you prefer?

Jim

Tim

either