I can't wait to see you!

My booking email: giorgiaherz@gmail.com

Please fill out the following form if you are interested in meeting me - I need to complete your screening before our first date. Same day requests are welcome!


The information you provide will be kept in strictest confidence and will be discarded at the end of the process; with the exception of your contact information and preferences so that you do not need to repeat the screening process in the future.


If interested in arranging some time together please copy and then paste the below info into an email and send it to me at: giorgiaherz@gmail.com.

 

First Name:

Last Name:

Phone Number:  

Contact Preferences: Is it ok to call? Is it ok to text? Is it ok to leave a voicemail? 

 

What is your age?  

Brief description of yourself.. i.e.: hair color, eye color, height, build, facial hair, glasses, etc...

 

Please provide any Memberships/Handles you have on the following sites:

P411:

TER:  

 

Provider references that you have seen recently. I highly recommend you contact your references to let them know that I will be reaching out to them in order to expedite the screening process.*  

 

Provider Reference #1 

Name:

Email:

Phone:

Website  

 

Provider Reference #2 

Name:

Email:

Phone:

Website:  

 

PLEASE NOTE: Should you not have any references, don’t give up hope … read the information below for other screening options:  

 

NEWBIE SCREENING: If you do not have recent references we can do a newbie screening. Please contact me for more details.