For my safety I require verification. All of your information is kept confidential. Please fill out as much of the following information as possible. Anything with a purple asterisk is required information.

If you are not able to use Preferred411 or provider references for screening then I will require all of the following information for verification: name of your employer, your position, work email, phone number, current city and state of residence, and a clear photo of your driver’s license held next to your face. A passport is acceptable if you are visiting from outside the U.S. All information on your driver’s license and/or passport must be visible.

If you are using employment information for verification a $25 non-refundable deposit will be required, which will be applied to your appointment fee. The payment link will be sent to you after I’ve received all the required screening information.

Any explicit correspondences, inquiries regarding services or rates, or mention of “menu” acronyms or terms is prohibited. Any mention of or inquiry about unsafe practices is prohibited. Any reservation form including anything prohibited will be ignored and will cause you to be put on my do not see list.