About You

First Name: 

Last Name:

Email Address:  

Contact Number (for Verification Purposes Only. I won't Call!):

Age:

Curious to Know....

How did you find me? * *

  •  Eros-Guide
  •  Backpage
  •  Slixa
  •  Nightshift
  •  TER
  •  P411
  •  Referral
  •  Other

If Other, please let me know what that was.

What is inspiring you to have a session with me? 

Session Details

  • Incall or Outcall? 
  • If Outcall, Where?
  • Desired Session:  Restored Awareness or Expanded Awareness?
  • Session Length (1 Hour,  1.5 Hours,  2 Hours)?
  • Session Date? 
  • Session Time? 

If I'm not available on that date, do you have a another, second choice date you are also available?

  • Second Choice Date &Time?

References or Employment Information

  • Verification Preference? (You can give me either another provider's name or Employment information.)
    •  Another Provider
    •  Employment
    • P411
* IF USING P411, PLEASE LOG IN TO YOUR ACCOUNT AND SEND ME AN EMAIL USING THEIR MESSAGING SYSTEM.

Provider Reference Information

  • Provider's Name
  • Link to Provider's Currently Running Ad
  • Another Provider Reference?
  • Link to Provider's Currently Running Ad

Employment Information

This can be your company website with your name and photo, a well-established LinkedIn profile with photo, blog posts with your name and photo?

Get to know you....

I would love it if you told me something about yourself <3

 

 

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