Preliminary Questionnaire

1. The Basics

17%

*
1. Name

Name

*
2. email address

email address

3. Telephone (area code) 123-4567

Telephone (area code) 123-4567

4. telephone

telephone home

work

cell

5. best time to call

best time to call

6. date of birth

date of birth

7. height

height

8. weight

weight

9. occupation

occupation

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

city in which you are requesting a session or attending a workshop

11. Preferred days / times for your session

	Morning	Afternoon	Evening	Any
Sunday	*Preferred days / times for your session Sunday Morning	Sunday Afternoon	Sunday Evening	Sunday Any
Monday	Monday Morning	Monday Afternoon	Monday Evening	Monday Any
Tuesday	Tuesday Morning	Tuesday Afternoon	Tuesday Evening	Tuesday Any
Wednesday	Wednesday Morning	Wednesday Afternoon	Wednesday Evening	Wednesday Any
Thursday	Thursday Morning	Thursday Afternoon	Thursday Evening	Thursday Any
Friday	Friday Morning	Friday Afternoon	Friday Evening	Friday Any
Saturday	Saturday Morning	Saturday Afternoon	Saturday Evening	Saturday Any

Other (please specify)

*
12. Length of session requested

Length of session requested INTRO (1 hr)

BASIC (1 1/2 hrs)

EXTENDED (2 hrs)

*
13. type of session requested

type of session requested 1-on-1 (2-handed)

2-on-1 (4-handed)

either

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

if 1-on-1 (2-handed) session, do you prefer? Jim

Kevin