Jamie's Secure Screening Form
"Discretion is the better part of valor."
Name
*
Occupation/Industry
*
Age
*
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Preferred method(s) of contact - select all that apply
Text me
Email me
Call me
Other
Photo/Selfie
Upload a File
Cancel
of
Nightshift Handle/TER ID
P411 Handle
LinkedIn Profile
Business Website
Business Card or ID
Upload a File
Cancel
of
References
Include name, email/phone & ad
Appointment Date Requested - 1st Choice
*
-
Month
-
Day
Year
Date Picker Icon
Appointment Date Requested - 2nd Choice
-
Month
-
Day
Year
Date Picker Icon
Time of Day
*
10am - 2pm
2pm - 6pm
6pm - midnight
Location
San Francisco
East Bay
Other
Length of Appointment Desired
*
1 hour
1.5 hours (outcall min)
2 hours
Snacks/Drinks Date - 3 Hours
Dinner Date - Up to 6 hours
Slumber Party - Up to 14 hours
Type
Incall
Outcall
Special Requests
How did you find me?
Anything else you'd like to share
Submit
Should be Empty: