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About You

Name: *
Age: *
City: *
Ethnicity: *

Contact Information

Email: *
Phone: *

Appointment Details

Preferred Dates/Times: *
Preferred Location: *
Preferred Length: *
Outcall or Social Location:
Any Likes or Dislikes:
Preferred Deposit Method:
If you selected CashApp deposit, what is your Cashtag?
Accommodations (optional, check any that apply):
Soft lighting and music
Energetic lighting and music
Natural beauty
Glamorous beauty
Lots of eye contact
Little eye contact
Lots of conversation
Little conversation
No perfume
Alcoholic beverages
Water only
420 friendly
Not 420 friendly
Electronic translator needed
I am deaf or hard of hearing
I am blind
I am neurodivergent
Handicap accessible incall
I have a medical condition that could potentially require medical attention
I have erectile dysfunction
Please limit physical touch
Other - will explain


How did you hear about me? *
Please list any forum handles or usernames (including Switter, Private Delights, or other ad or review site): *
Provider Reference 1 Name and Email:
Provider Reference 2 Name and Email:
I don't have references and agree to be verified via background check:
I agree

I can't wait to meet you! Please help me streamline the screening process by filling out the following form.This will also help me to ensure you get the best possible experience with me. For general, non-booking inquiries, please email me at

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