If you’re ready to meet, this is the form for you. I only reply to forms that are completed properly, so please be thorough.

Use at least one of these screening options:

  1. Two recent provider references
  2. Your Linkedin/company website and a blank email from your work email (I have a discreet, unlisted email you can use for this, just ask)
  3. Gov’t issued ID (showing full name, DOB, and photo only)

You can also email me the required information at I value discretion and your information will be kept private.‚Äč

I’m selective about who I spend time with. Taking the time to thoughtfully fill out the form goes a long way. I look forward to meeting you.

    Your Details

    * Full Legal Name:

    * Email:

    * Date of Birth:

    * Telephone Number:

    Appointment Details

    * Date of Booking:

    * Time of Booking:

    • :

    * Duration:

    * Incall/Outcall

    * Please provide your location name and address:

    * Please provide your location name and address including country & city:

    Screening Options
    (choose your preferred method of screening)

    1. Companion References
    Minimum of 2 references from companions you have visited in the last 12 months. Name, website & email.

    * Companion reference 1:

    * Companion reference 2:

    2. Employment Verification

    * Position:

    * Company name:

    * LinkedIn page:
    with profile picture.

    3. ID

    * Please provide a copy your photo ID:

    Additional Information


    * Where did you hear about me?

    * If other, please state below:

    * Please enter the directory name below:

    * Love letter: