Initial Contact Form

Initial Contact Form
Everything you enter in this form is encrypted.
Nothing you share with me is ever shared without your explicit permission.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Communication over email is preferred.
Location
Where are you?
Duration
I tend to prefer longer meetings to shorter ones.
Describe Yourself*
Pronouns, Age, Occupation, Hobbies, Etc
What is something that you are passionate about? Why is it important to you?
Share something that matters to you and is personal.
Time of Day Preference
Day of Week Preference
What are some of your interests?*
Please don’t write an explicit play by play. A short description of your interests or a list is perfect.
Any hard limits, limitations or health concerns?
Use this to communicate any limitations you have, in scene triggers or things you need to avoid.
Screening

Please use one or more of the methods below for screening. I keep everything confidential and secure. Feel free to ask questions or send information over email if you are more comfortable. :)
First Screening URL
Linkedin, Facebook, Twitter, Instagram or Professional Website
Second Screening URL
Linkedin, Facebook, Twitter, Instagram or Professional Website
References
Websites or Emails of other Professionals you have seen. A name is acceptable if it has been a while. If you have no references, write N/A.
Other screening methods

I will send a photo of my IDI would like to schedule a phone interviewI would like to meet over coffee
Third Screening URL
Linkedin, Facebook, Twitter, Instagram or Professional Website
Third Screening URL
Linkedin, Facebook, Twitter, Instagram or Professional Website
Additional Social Media Accounts
Please format as a link. Examples: Linkedin, Twitter, Facebook, Instagram, Personal website
Should be Empty:

Initial Contact Form

Screening