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APPOINTMENT REQUEST FORM
CAN'T SUBMIT?
Required fields (indicated with an "*") must be completed before you can submit your request. If your form won't send, make sure you filled out the required items.
NO PHONE NUMBER?
If you choose not to give me your phone number during screening, PLEASE DON'T TEXT on the day of our meeting. I'll be checking for YOUR messages. Without your name attached to your number, your text will be one of many. In other words, I won't see it, especially on tour.
SCREENING:
-P411, RS2K, and returning clients: No other screening required. You can just email or text me. You don't have to complete another appointment request form.
-ALL OTHERS: You will need to provide a copy of your ID, a selfie, and either prepay a discounted rate or pay a deposit plus cash in person. Let me know if you'd like a p411 invitation.
BOOKING ON TOUR?
On tour, either a deposit plus cash a or discounted prepayment is required from everyone (check rates page). Payments are made on venmo or cash app. A deposit only can also be paid on amazon.

Are you a P411 member, or have we met before? P411, send a P411 appointment request or send a P411 private message. If we have met, just email or text me with the day and time you'd like to meet.

First Name

Last Name

Phone number...If you don't give this to me, DON'T TEXT ON THE DAY OF OUR MEETING PLEASE!.

Email Address (IMPORTANT: Double check for correct spelling)

Your Age Range

Okay to call or text? I will try to accommodate your request, but discrection is YOUR responsibility. There are apps available that will give you a secret number that will require a password to use.

Select a date. If you are flexible, unsure, or just want to be pre-screened, just let me know in the notes at the bottom of the page in the comments section.

Desired Start Time. I'm normally available 11 am to 10 pm 365 days a year. Prebooking is recommended. I'm often not availabe for same day appointments. My tour my schedule is usually full before I arrive.

In call (my place, in call only on tour) or out call (your place) .

Amount of time: There are two payment options: prepay for a discount, or pay cash in person. There is a deposit required with the cash option for everyone on tour, most first time clients in Northern Illinois and Wisconsin, and for meetings longer than 2 hours.

Do you want to pay a discounted and nonrefundable rate, or pay cash in person? A deposit is required with the cash option for everyone on tour, for less than two references, more than 2 hours, other possible reasons

Which city do you want to meet in? NO SUBURBS OR NICKNAMES, PLEASE. Tour cities by name, Chicagoland, Wisconsin cities, or another for fly me to you.

Which screening information will you provide (must choose one)?

What Interests You? (See entertainment ides page). Check all that apply. You can elaborate in the comments. There are special instructions for actvities with an astrik. Ask the booking agent about them!

Traditional GFE

Tantra

*BDSM

*Role Play

Photos and Video

*Bring my significant other

*Multiple female providers

Swingers Club (special rates)

Learn about Viagra

*Learn about mind-altering experiences (3H minimum)