Contact

Name

First Name

Last Name

Email

Phone Number

* No Text Apps

Message

Please tell me a little about yourself. How did you find me? What made you choose me?

City

Date

MM

DD

YYYY

Time

Hour

Minute

Second

Incall or Outcall

please check one

Incall

Outcall

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Please fill out my booking form in full, this ensures a quick response and a confirmed appointment.

Screening

For safety reasons, I require screening prior to all appointments. I understand the importance of discretion, and please note that all information provided will not be saved or stored after verification. If you are uncomfortable sending this information through the booking form, please feel free to email it to me separately.

To secure your appointment, please provide just two screening methods from the following options:

• A photo of your ID (only name, birthdate, and photo need to be visible)

• Your LinkedIn profile

• Two reputable provider references

• A business card

• A work ID badge

Thank you for your understanding and cooperation.

booking.roxannevip@gmail.com
(813)515-3750