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
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
Type Of Session
1 HOUR FETISH SESSION (300)
90 MINUTE MASSAGE (300)
90 MINUTE BONDMASSAGE (325)
90 MINUTE MASSAGE FETISH (400)
2 HOUR - I HOUR MASSAGE/1 HOUR FETISH (500)
1 HOUR COMPANION (300)
90 MINUTE MASSAGE / COMPANION COMBO (400)
2 HOUR COMPANION WITH MASSAGE & FETISHES INCLUDED (600)
Kinks, Fetishes, Special Requests?
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
Preferred Initial Contact? (email/call/particular hours?)
To Expedite Screening You May Attach Screenshot Of LinkedIn Profile, Photo Of Business Card Or Work ID.
Browse Files
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of
Website Where You Originally Found me?
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