Name
*
First Name
Last Name
Age
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How did you find me?
*
What do you seek?
*
BDSM
BDSM+
Desired session length?
*
1 hour
2 hours
3 hours
Preferred session dates and times?
*
Preferred playtime location?
*
San Francisco Bay Area (4-5 star hotel)
East Bay dungeon
I require a 15 minute video call to assess compatibility/chemistry Choose your ideal date and time and I will confirm or tell you an alternate time via email.
*
What are your limits (soft, hard, physical, emotional, verbal)? Be specific as possible.
*
What do you want to explore with me? What drew you to me?
*
Have you seen a provider in the last year? If so, please provide names/email addresses/websites along with the session date.
*
Upload a copy of your government issued ID here. This is kept confidential and used for screening to ensure my safety.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you consent to marks being left on your body?
*
Yes
No
If interested in receiving anal play, have you read and do you agree to prepare as directed?
*
Yes
No, not interested in recieving anal play
Anything else you would like me to know?
Submit
Should be Empty: