Booking Form

SESSION REQUEST FORM

All of this information will be kept completely confidential
Name*

First NameLast Name
Pronouns
Cell Phone Number*

I will never call or text you without consent.
Cell Phone Number*
I will never call or text you without your consent.
E-mail*
Email is my preferred method of communication. For the safety and descretion of both parties, I use encrypted email that is hosted abroad, I encourage you to do the same.
Session Details
Preferred time(s) for session (Select all that apply)

MorningEarly AfternoonLate AfternoonEarly EveningLate EveningsNight Owl Hours
Preferred session date*

MonthDayYear
Other session date

MonthDayYear
(if preferred date is not available)
Session length*

15 Minutes (Digital only)30 Minutes (Digital only)1 Hour1.5 Hours2 Hours2.5 Hours3 Hours3.5 Hours4 Hours4+ HoursWeekly TaskOther
Session Location (*Indicates an additional fee may apply)*

Incall*OutcallOutcall (the suburbs and beyond)*DigitalOther
Screening Information*
Name and contact info of two provider you have seen before OR social media handles OR Linkedin profile/employment verification OR state ID
Upload ID here

Browse Files
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Intake

Tell me a bit about yourself
Goddexx Demeanor (Select all that apply)*

SternNurturingCruelAloofPlayfulStrictBrattySmart AssOther

SESSION REQUEST FORM