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Booking Form

Please take a moment to fill out the form.

First Name

Last Name

Phone

Place of Work

Location

Preferred Times & Dates

*Remainder of fee to be paid in cash upon meeting

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Details of any medical issues that could affect our time together?

Please upload a picture of you holding your drivers license (showing your face and name clearly; you can block out your address.

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Anythig else you would like to add?

I’ve read and understood the information on this website, including rates, services and safety information and understand that these are non-negotiable. I acknowledge any attempt to cross these boundaries will result in my immediate termination as a client and forfeit any payments.View terms of visit

Thanks for your enquiry!