Session Request Form
All fields must be answered.
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
A LINK to your Social Media presence or business website. Social media must show your REAL NAME. I will not try to friend or connect with you there.
*
Birthdate
*
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Month
-
Day
Year
Date
May I send a text?
Yes
No
Where did you find my website?
Tryst
Twitter
ThatMall
Sacred Eros
Google Search
Traditional Bodywork
Other
Do you have any past experience?
*
What calls you to this experience? What are your intentions and desires?
*
Do you have any physical or medical issues that could prevent you from moving your body easily? Are you pregnant? Any medications that affect the heart or blood pressure? Diabetes? Any allergies?
*
What is your passion in life?
*
What are your pronouns? He/Him, She/Her, They/Them, etc.
*
Desired Session Date/Time? Please keep in mind my business hours of Mon-Fri 11:30am-6pm/Sat-Sun 12:00pm-5pm
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Day
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Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Which session would you like? We will finalize details later.
*
Please Select
Thera-Sensual
Neo-Tantric
Japanese Silk/Nuru
Bondassage
Elysium
Sensual Shirodhara
50 Shades
Length of session?
*
Any enhancements? Please check my rates page for those.
*
How would you like to send your deposit? I will be giving you my details in my follow up email.
*
Venmo
Cashapp
Amazon gift code
Stripe
Make sure to check your spam box for my reply!
Please verify that you are human
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