APPOINTMENT REQUEST FORM

Are you a returning client, P411 or RS2K member?

First name

Last name

Phone: If you don't provide your phone number DON'T TEXT THE DAY OF OUR MEETING.

Okay to call or text? I will try to accommodate your request, but discrection is YOUR responsibility. There are apps available that will give you a secret number that will require a password to use.

Your Age Range

Select a date. If you are flexible, unsure, or just want to be pre-screened, just let me know in the notes at the bottom of the page in the comments section.

Desired Start Time. I'm normally available 11 am to 10 pm 365 days a year. Prebooking is recommended. I'm often not availabe for same day appointments. My tour my schedule is usually full before I arrive.

In call (my place), out call (your place). No out call on tour.

Amount of time:

Do you want to prepay for a discounted rate, or pay cash or a deposit plus cash?

Which city do you want to meet in? PLEASE ONLY LIST MAJOR CITES. Select a city on my tour schedule, Chicago, Milwaukee, etc. Don't choose a suburb.

Which screening information will you provide (must choose one)?

What intrests you?

Traditional/GFE

Role play

Multiple providers

Photos and Videos (1.5 H +)

BDSM (1.5 H +)

Tantra (1.5H +)

Wardrobe request (1.5 H +)

Bring significant other (1.5 H +)

Learn about viagra, 50 and up (1.5 H +)

Swingers Club experience (2H minimum)

Magic Mushrooms (3H mimimum)

Overnight/FMTY

COMMENTS: Is there anything else you'd like to tell me? NOTHING LEWD OR SEXUAL, PLEASE.

How many times have you met with a provider? * Required

This is my first time

This is my second time

This is my third time

4 to 7 times

8 to 15 times

16 to 25 times

More than 25 times

Will you help me with advertising by telling me which sites you use when searching for a new provider?

I accept terms & conditions

Thanks for submitting your appointment request. If you don't hear back from me within 72 hours, please contact me. I look forward to seeing you soon!

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