Request An Appointment
Response Is Usually Within 2 Hours BUT Please Call If Hoping For Same Day Availability. Thank you!
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Profession
Age (Must be over 30)
Requested Appointment Date
-
Month
-
Day
Year
Date
Date Picker Icon
Requested Appointment 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
Type Of Session
90 MINUTE MASSAGE (300)
90 MINUTE BONDMASSAGE (325)
4 HOUR LUNCH/DINNER DATE W/MASSAGE (600)
6 HOURS SOCIAL TIME W/MASSAGE (800)
1 HOUR COMPANION (350)
2 HOUR MASSAGE/COMPANION COMBO (550)
90 MINUTE MASSAGE/COMPANION (425)
Special Requests? Fetishes?
How often Do You Masturbate?
Rarely
1x A Week
3x Or More A Week
1x A Day
Multiple x a day
Any Issues With:
Getting Hard
Staying Hard
"Going" Too Fast
Not Being Able To "Finish"
Do You Have Any References?
YES
NO
Time Preferred For Initial Contact? (particular phone hours?)
To Expedite Screening You May Attach Screenshot Of LinkedIn Profile, Photo Of Business Card Or Work ID.
Browse Files
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Website Where You Originally Found me?
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