Secure Application Form

Secure Application

For your confidentiality, this form will be encrypted and sent to a secure email address.

I am highly selective in accepting new clients. Take time to fill out this application thoughtfully.

Novices are not expected to be able to answer every question. Answer to the best of your ability.

* = Required Field

Contact Information

Name *

Email address *

Phone number

May I contact you at this phone number? Yes No

Is it ok to leave a discreet message? Yes No

Preferred city, date(s) and time(s) for your appointment? *

Alternate dates and times, if your preferred appointment is not available? *

Create Password

Our email correspondence will be sent from a discreet email address in encrypted and password protected form, bearing the title 'RE: application' This will work even if you are using a regular email account that does not support encryption. Create a unique secret question and answer that no one but you knows the answer to and that you do not use for other email accounts.

Secret Question

Answer (lowercase only)

I read the boundaries statement and I agree to respect all boundaries. I understand that
sexual contact and nudity are not offered and will not occur.