Return Client Contact Form

Return clients may use the contact instructions they were given during their last appointment. Email and phone changed as of 6/08. Use this form if do not have current contact information.

All information entered will be encrypted and then sent to a secure email address. New clients must use the Secure Application Form.

* = Required Field

Contact Information

Name *

Email address *

Phone number

How would you like to be contacted? Phone Email No Preference

What time/s of day may you be reached?

Is it ok to leave a message? Yes No

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

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)

Additional Information

When and where did you last see Katja Starkova?

Describe yourself physically, emphasizing anything unique.

What are your main submissive interests?

What was it about your past experience with Katja that inspired you to contact Her again?

Additional comments or questions?

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.