Apply to Serve

First name

Last name

Age

Phone Number * - I will only reach out to you by phone with permission. Your phone number is required as part of my screening process. Giving a fake phone number is deceitful and will prevent your application from being processed.

Do I have permission to reach out to you via text to the number you provided above?

Yes

Requested Appointment Day/Time - 48 hour notice

Month

Day

Year

Time

HoursMinutes

Duration of session

I understand and agree to pay the rate of

$300/30 mins

$500/hour

Why do you want to serve me?

Favorite Kinks?

What are your soft limits? A soft limit is a boundary that a person may hesitate about or place conditions on, but may still consent to.

What are your hard limits?  Hard limits are absolutes. These are the things that you will not do, under any circumstances  

References from other providers*  Without a reference, a legal name & photo ID will be needed 

You may mark out any details other than name and photo. Providing ID is mandatory, I will not allow you into my space without verification.

Do you have any medical conditions I need to be aware of?

Permission to record or take photos for my social media (nothing identifiable)

Yes

What else would you like me to know? Be as detailed as possible about what you're seeking in our session

I understand and agree to pay my deposit of $250 to Goddess Anastasia's:

Cashapp

Venmo