Screening

New friends must be screened and verified before reserving a session. For your safety as well as mine there are no exceptions. To facilitate this process please complete my secure screening form in its entirety. Failure to do so will delay your verification. Please allow up to 48 hours for me to reply.

Click for Secure Screening

Name *

First

Last

Email *

Age *

Phone Number

Preferred Contact Method

Text
Voicemail

LinkedIn Account

Preferred 411 Handle

Photo ID AND Matching Selfie

Click or drag files to this area to upload. You can upload up to 3 files.

photo ID (hide address), matching selfie, and optional business card

Provider References (only required in absence of photo ID)

First Provider Reference (within 6 months)

First Provider Reference Email

First Provider Memory Jogger

Second Provider Reference (within 6 months}

Second Provider Reference Email

Second Provider Memory Jogger

Appointment Details

Requested Date / Time

Date

Time

Requested Duration

Interested in a Duo?

Yes
No
Maybe

Message

Please note the following:

All appointments require reasonable notice due to my other commitments.
Cancellations under 24 hours require a 50% fee to reschedule.

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Screening

Provider References (only required in absence of photo ID)

Appointment Details

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