Booking Form

Appointment Request Form

If this is our first time meeting or you would like to pre-book an appointment with me, please use this form. I will get back to you as soon as possible, thank you! (If we’ve met before or you’re trying to meet immediately, just call or text me.) NOTE: I take security/privacy VERY seriously. Please be aware that once submitted, all data on this form is heavily encrypted and can only be accessed by me using a randomly generated encryption key. If you have further questions please let me know.
Full Name*

First NameLast Name
Email*
name@example.com
Phone Number*
Preferred Contact Method*

PhoneEmail
Age*
Race*

Black/AfricanWhite/CaucasianLatino/HispanicAsian/Pacific IslanderOther
What type of work do you do?*
Only the TYPE of work is required, not the specific company.
Where did you find me?*

TrystAdultSearchP411PrivateDelightsOther
If you selected “other” above, please explain.
When would you like to see me?*

MonthDayYear
Date
Time AM/PM Option
What type of appointment are you looking for?*

Incall (You come to me.)Outcall (I come to you.)
How long?*

30 mins ($150)1 hour ($250)90 mins ($400)2 hours ($500)
How long?*

30 mins ($200)1 hour ($300)90 mins ($400)2 hours ($500)Overnight (I will contact you for more information.)
Are you aware that ALL outcalls require a $50 deposit? (Or you MAY have the option to Uber me to you and back.This is at my discretion and is NOT subtracted from the donation.) *

Yes
Are you okay with coming to a hotel? *

Yes
Are you okay with my puppy (small shih tzu, ~8 pounds) being in the room? If you have an issue such as dog allergies, please email me!*

Yes
Where is the outcall?*

My homeA hotelOther
If “other” is selected, please tell me what type of location it is.*
What is your address? *
Please give me an exact address so that I know where I’m coming to.
Is there anything else you would like to tell me about yourself or your desired appointment?
Should be Empty:

Appointment Request Form