Jamie's Secure Screening Form
"Discretion is the better part of valor."
Name
*
Occupation/Industry
*
Age
*
Ethnicity
*
E-mail
*
Phone Number
*
Preferred method(s) of contact - select all that apply
Text me
Email me
Call me
Other
Upload a Photo or Document for Easy Verification
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of
Take a Selfie
Nightshift Handle/TER ID
P411 Handle
LinkedIn Profile
Business Website
Business Card or ID
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of
References
Include name, email/phone & ad
Appointment Date Requested - 1st Choice
*
-
Month
-
Day
Year
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Appointment Date Requested - 2nd Choice
-
Month
-
Day
Year
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Time of Day
*
10am - 2pm
2pm - 6pm
6pm - midnight
Length of Appointment Desired
*
0.5 hour (incall only)
1 hour
1.5 hours
2 hours
3 Hours
Bespoke
Location
San Francisco
East Bay
Other
Location Type
Incall
Outcall
Special Requests
Anything else you'd like to share
How did you find me?
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