WAYCO Coaching with Jason Bechtold Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Goals What are the three biggest changes you want to make in the next three months? What are the top three things holding you back from achieving them? What would you say are your three biggest accomplishments to date? What is the hardest thing in your life you have had to overcome? Have you worked with a coach before? If so, what worked well and what didn't? Your Life On a scale of 1-10 (10 high), rate the amount of stress in your life currently. What are your primary stressors? List five things that you are tolerating or putting up with in your life at present. (Examples: information you can’t find, clutter, rude friends, dented car, job dissatisfaction, dead plants, broken equipment, old appliances, etc.) Yourself List 5 words that describe you at your best. What motivates you? What are you learning about your life? On a scale of 1 to 10 (10 high), rate the quality of your life today. If you reach the age of 95 and continue to live your life and order your time the way you are right now, what regrets do you think you will have? (Tip: complete the statement “I wish I had…”) Do not include things from the past—only things you will regret if you continue your exact present path. Any additional comments: May I have your permission to record our call for training purposes? * Yes No Thank you!
