Screen & Book Me

* Required Field

About You

Name: *
Age: *
Location, If Requesting An Outcall:
Ethnicity: Please Click One: *
Occupation: *
Relationship Status: *
Were You Born Here, Are You Visiting, Or Are You Here For Work/Business? *
Send Me A Recent Clear Picture: *
Send Me One Of The Following: A Work Related Photo. It can be a work ID, business card, work uniform or badge, or a photo of you on the job. You can blur out any important information. I just need the photo to verify you're safe. It will be deleted. *
Did You Read And Comprehend My Entire Website Before Coming To This Page? *
Are You Affiliated With Any Law Enforcement? *
Do You Agree This Isn't A Form Of Entrapment For Arrest, By Contacting Me? *
Do You Agree You Are Not Affiliated With Any Law Enforcement By Contacting Me And Submitting This Form? *

Contact Information

Phone Number: *
Accepts SMS/Text Messages? *
Email:
Best Times To Text/Call/Email:

Schedule A Meeting With Me

Exact Date/Time You Want To Meet Me: *
Incall or Outcall? *
What Would You Like To Do From My Menu? *
Outcall Location, If outcall is desired.
Wardrobe Request(s):
Special Request(s):
Any Likes or Dislikes:

References

How did you find out about me? Please list where exactly. If it was online, put which sites. *

Health Check- PLEASE trim or shave any areas you would like me to pay extra attention to. ;-)

HAVE YOU EVER BEEN DIAGNOSED WITH HIV/AIDS? *
HAVE YOU EVER BEEN DIAGNOSED WITH A STD OR STI? *
DO YOU HAVE ANY ON GOING CONDITIONS? *
DO YOU HAVE ANY COMMON COLDS? COUGHING? RUNNY NOSE, SNEEZING? PINK EYE? ANYTHING CONTAGIOUS? *
DO YOU DO ANY HARD DRUGS? *

Here you will be able to book me. You can see my schedule, and see what time works best for us both. Feel free to fill out the screening form, and I will get back to you at my earliest convenience with a text. If you don't feel comfortable sending in the screening info, text me. Some form of screening will be required; and is mandatory for all new friends! Screening is for my safety, freedom, and to gain my trust. All of the information you send in to me, will ONLY be viewed by me, and will be deleted in 24 hours after submission.

Discretion is most importantly key!

Thank you so much for your cooperation and have a beautiful day.