Session Request Form
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
What date and time are you requesting?
*
Any other specific date and time, if the above selection is not suitable.
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
How do you want to feel in session, and what do yo want to experience? What are your goals and boundaries?
*
Choose a screening method/ Either 1: Reference information or 2: Paid phone consultation + Linkedin or 3: Paid phone consultation + Photo ID next to your face
*
How did you find me?
*
Provider site
Social media
My website
Google
Other
Choose your Deposit method
*
Cashapp
Venmo
Wishtender
Visa gift card
Terms and Conditons Agreement: By providing your signature you are agreeing to assume full responsibility and full liabilty for your health, safety, and well-being. that you willfully disclose all medical and health conditions that may impact any aspect of this and any future engagments, and that you are of sound mental and emotional health that are required in order to fully engage with any/all elements of BDSM and kink exploration
*
Continue
Continue
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