đź“ŤPre-Insight Call Questionnaire

Thank you for taking the first step towards our work together!

Please fill out this form honestly and thoughtfully.

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Email *
Name? *
If our journey together calls for a more immediate conversation, what phone number can we reach you at? (please include country code) *
Relationship Status: *
What's the one challenge in your life or relationships that weighs on you the most at this moment? (Be brutally honest. What keeps happening that you know needs to change?) *
Can you tell me how these patterns are affecting your daily life and your ability to connect with others? *
What kind of support do you feel is missing in your life when it comes to relationships?
 *
If there's one thing you'd hope Jeremie could help you achieve, what would that be?
 *
Are you currently interested in having ongoing personalized support, structure, and accountability ?
 *

As we explore this work together, it's important to also talk about the investment involved.

Our private mentorship packages typically range from $500–$3,000(with installment options) If its a HELL YES for both of us are you ready to make this kind of investment in yourself?

 *
Anything else you'd like to share with Jeremie?
A copy of your responses will be emailed to the address you provided.
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