Drea's Appointment Request
Name:
*
First Name
Last Name
Email
*
example@example.com
Resident City & State:
Age:
Contact Number
-
Area Code
Phone Number
Online Screening Service
If you are a member of one of the following screening services, please provide the necessary details I need to verify you.
Preferred411.com:
TER Handle:
Companion References
If you are a member of one of the following screening services, please provide the necessary details I need to verify you.
Reference #1
Reference #2
Employment Information- Only needed if no other screening available.
Please provide employment details below for screening purposes
Company name:
Your position or title:
Company website:
Main company phone number:
Your direct line and/or extension:
Phone etiquette or cover story to use when calling?
Appointment Details
Please outline your appointment preferences below.
Preferred Date:
*
-
Month
-
Day
Year
Date
Preferred Time:
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Duration:
*
1 hour
1.5 hours
2 hours
3 hours
4 hours
5 hours
12 hours – Drinks/Dinner/Overnight
1.5 hours
16 hours – Drinks/Dinner/Overnight 7pm-11am
24 hours
48 hours
Location Address:
How did you find me?
*
Is there anything else you'd like to tell me?
I certify that I have read the Considerations page of Drea's website and that I am familiar with cancellation and deposit policies and will follow them.
*
Yes
No
Personal Photo (Optional)
Browse Files
Cancel
of
Submit
Should be Empty: