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)
Preferred session date

MonthDayYear
Other session date

MonthDayYear
(if preferred date is not available)
Session length

Other
Session Location (*Indicates an additional fee may apply)

Other
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

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Intake

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

Other
- I'm interested in (Select all that apply)
  
  Other
- Clothing Request:
- What would you like to focus on in our initial session?
- Which of the following best describes your experience level?
- How well would you say you know your limits?
- Can you take marks?
- What are you hard limits?
  This may include names, topics, etc.
- What is your relationship to pain?
- If there are any particular things you like to be called or teased about, what are they?
- What do you like to do for aftercare? How long do you like to spend on aftercare?
- Do you have any medical issues or allergies I should know about?
- Is there any past trauma I should be aware of?
- Anything else I should know?
- How did you find me?
- Agreements and Acknowledgements
- By clicking below you certify that You are at least 18 years of age. You have read this agreement and fully understand the contents thereof. You agree that you have the legal authority to grant these permissions and accept all responsibility for such.
- If you need to cancel our session please notify me immediately! If you cancel with less than 48 hours notice, a cancellation fee of 50% of the total tribute is required. If you cancel within 24 hours of the session, a cancellation fee of 100% of the total tribute is required. Deposits and half of the cancellation fee can be applied to a future booking if scheduled within one week of the cancelled session date. Cancelling or rescheduling twice will result in the forfeit of your deposit and any portion of the cancellation fee that may have been used for a future session. Re-scheduling without deposit forfeit may occur at my discretion if you give at least 48 hours notice and the session is rescheduled within 2 weeks of the original session date.
- Should be Empty:

SESSION REQUEST FORM

Session Details

Intake

Agreements and Acknowledgements