Booking Request Form
Rev. Mistress Dahlia
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Age
*
Location
*
What specific activities would you like to explore during our session?
*
Please describe your level of experience as a submissive.
*
When would you like to book your session? Please provide me with 2-3 options so I can ensure there's no scheduling conflicts
*
How long would you like to book for?
*
Location for session? Dungeon, Hotel, or Home? I am currently only providing dungeon sessions in Philadelphia and NYC.
*
Please list any boundaries or limits you have.
*
Do you have medical conditions, disabilities or allergies?
*
How would you like to verify?
*
Please Select
Option 1: Photo ID
Option 2: Provider Reference
What Happens Now?
I will contact you within 24 hours. Please check your spam folder if you don't hear back from me within that time frame. If more than 48 hours passes and you haven't heard from me or my assistant, please email me at dahliakahlil@proton.me to verify I've received your request.
Deposit, Space Rental, and Cancellation.
You can expect to pay 25% of the full session price upfront. I have to rent space for our session, please expect to pay rental fee in addition to any deposit if applicable. If you cancel within 24 hours I will refund your deposit. Space rental fee is non-refundable, as I book the space and refund policies for hotels and dungeons are beyond my control.
If using ID to verify please submit here:
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