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Responses can take 3 - 72 hours. (I will only contact you by chosen contact method)

I am a very discrete individual as I can only assume you are as well. However, my safety and well being are paramount. Anything shared between us is not used to disrupt your reputation or to blackmail you. It's literally just safety protocol.

Full Name *
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Email *
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Level of Discretion Needed Upon Contacting You *
A Brief Description of Yourself and Your Expectations of Us *
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Desired Date *
Desired Time *
Duration of our date *
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Do you have any Allergies, Disabilities or Concerns you'd like to let me know about? (if none leave blank.)
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Preferred Method of Screening *
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