Your Name:
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Your Age:
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Where did you find me?
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List 3 session date/time requests:
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Do you prefer to host or be hosted? (Check all that apply)
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Which of my session offerings interest you?
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Offerings may be combined, rate determined at my discretion.
Are there any add-ons you'd like to incorporate?
Which energies describe how you would like feel during our time together?
Within a session, what tickles your fancy? (Check 1 or more)
You are a/n:
Name a desire, a fear, and a boundary:
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Screening: You must provide at least one of the following in order to see me. Check which options you will do, and submit the necessary materials in the textbox or via email.
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Please read carefully. Do note that further verification via selfie or screening call may be requested.
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Anything else you'd like me to know?
How would you like me to contact you?
Phone
Email
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By submitting this form, you certify that:
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Thank you for your information. I look forward to learning about you. I will be in touch within 48 hours. In the meantime, give me a follow on Twitter, and consider gifting an item from my list on Wishtender to grab my attention. Links below. Blessings!
