Hi,

Welcome!

Please can you complete my application form below for the Premier Programme, so that we can see if we are a good fit.

Full Name

Phone *

Email *

Country

State

City

What is it that you want most in your life?

What would it feel like to have this result?

What are you currently doing to try get this result?

What obstacles, challenges or struggles do you regularly come up against?

What would you like to see happening in your life in only a few months from today?

What is it worth for you to have these results? Are you ready to invest greatly in yourself?

By providing my email and phone number, I agree to receive emails and text messages related to Remi Stern's Relationship Coaching.

Hi,

Welcome!

Welcome! I am so excited you ended up here. I can't wait to get to know you.

Please answer the following questions. They give us a better understanding of the life YOU want to live. But don't worry, we will do a lot more digging together to uncover where you want to go and how you will get there.

Please note, this form is private and secure and no-one will read your responses except for me.

Let's get started :)