Screening Form

Some alternative options for screening if you do not have a provider reference would include 1 of the following:

  • Photo Verification (facial picture with Photo ID held up next to face and clearly visible.  You may blur out ID number and street address if listed)
  • Verification from your work email
  • LinkedIn website

Rest assured, this is strictly for safety precautions. This is completely confidential and your profile is automatically deleted by this domain within seven days.

When you decide to explore your inner self and achieve higher satisfactions...
Please contact me by completing the mandatory pre-screening form below:

* Required Field
About You
Yes to either Text only Neither
E-mail Text
Yes No
Our Time Together
Consultation (HHR) Sensual (HR) Pamper (90 Minutes) Relaxation (2 HRS) Wine and Dine (3 HRS) Extended (4 HRS) Luxurious (8 HRS) VIP (14 HRS) Weekend Getaway (48 HRS)
Alternative Screening
Answer this question to prove you're human: