Please note, screening is absolutely necessary and mandatory. My safety is paramount and no exceptions will be made whatsoever. I am an entirely independent practitioner and it is necessary for my safety and security to verify everyone with whom I may meet. You can rest assured that your information will be handled in the strictest of confidentiality. No one other than me will have access to your information, and all details are promptly and thoroughly discarded immediately after meeting you the first time. It does not serve me well to hold onto these details, and I value and respect your need and concern for privacy and discretion (a safety protocol for us both). 


*** In light of the new laws that have passed I prefer to receive screening information via booking form provided below OR via email  If emailing, please be sure to email ALL fields below. ***


Name *
Phone *
Preferred Date *
Preferred Date
Preferred Time *
Preferred Time
Where would you like to meet? *
Verification Information
Please send information for ONE (at least) of the following options. Please note: - No direct lines; Call must connect via receptionist and you must answer when dialed - Provide reason I should say I am calling (ex. to confirm doctor appt, dry cleaners, etc.) ~ Include link to providers website, phone number/email, and date of last meeting.
Please tell me a little about yourself? Age, Height, Weight , Ethnicity, Occupation.