The information you provide here is used only to verify you and is not saved. I am very discreet, and WILL NOT phone your home number or your work number. You will receive an e-mail reply within 12 hours, but usually much sooner. If this is your first inquiry, please do not try to contact me by phone. If this is your first inquiry, you may e-mail me if you wish, but I will still require all the information below. |
| Full name as shown on drivers license. You will be asked for drivers license during first appointment. |
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| Preferred date and time of appointment |
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| Name, phone, and e-mail address of another known provider that you have previously seen (required for appointment) |
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| Your utmost professionalism and courteous behavior is required. Please do not try to discuss sex acts, money, or use foul language. |