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About You

Name: *
Age: *
City: *
Relationship Status:
Occupation: *
Linked In url:
Facebook link:
Twitter handle:
Instagram handle:
Photo (optional):

Contact Information

Email Address: *
Phone number (no app numbers!!): *
Phone number to use to contact you (if different):
Preferred method of contact: *
Best time to be reached:

Appointment Details

Preferred Dates/Times: *
Preferred Location/ City: *
Preferred Date Duration: *
Wardrobe Request(s):
Special Request(s):
Incall or Outcall?


Names and contact info of providers you've seen before (must be within last 6-12 months and reputable):
Board handles (TER,GBN, Tryst, PD,ECCIE,Adultlook, Erotic Monkey etc):
Which site did you find me on? *

 If you are seeking to arrange a meeting with me please start by filling out this form.  Screening is done both for my safety and yours and to preserve the integrity of the community.  I do not make appointments with anyone until I receive this intake form and have a chance to review it- NO EXCEPTIONS.  Your information is handled with extreme discretion and you can rest assured I would never use any of it maliciously- any reputable lady in this industry sure wouldn't risk her livlihood in such a manner.  I only require what I need to feel completely comfortable seeing you as that is key to us being able to relax and enjoy ourselves during our time :)  If you have a question about anything on the form please email me at [email protected].


I DO NOT meet with anyone under the age of 21! Sorry


*Discretion and safety are paramount to me and I obide by strict ethical codes of conduct- you are in good hands :)