Screening Form

Discretion is extremely important to me. For this reason, I do screen and verify each and every person prior to meeting. As my privacy is valuable, I respect that yours is as well. Rest-assured, all communication is for my eyes only.

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Personal Information

References


Please provide names and contact information of at least TWO providers you've recently seen. Name, email, and website.

Appointment Details

Date

Time

Duration

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