Screening Form


Please fill out this booking form. This is perfectly discreet and is not stored in the cloud or on this website. Your uploaded information goes straight to my email. Once you are cleared, all identification is destroyed.

I live in the East Bay part of Alameda County not far from Berkeley California. I have a luxury private residence that has a discreet set up. I provide my services at this residence and will consider outings only after I know you and only if tribute well. You must be a discreet polite respectful gentleman when entering my community.

I do not take references from LinkedIn or P411.

  • Tell me your idea of a good session together. Describe your limits or dislikes. Do not describe any illicit or sexual things here as your request will get permanently ignored. If you need to talk to me, that will be done in private at my location. When filling out this form, be a gentleman and be discreet at all times.
  • Please upload a selfie holding up a piece of paper with today's date on it. This is required regardless of which screening option is used below.
    Drop files here or
    Accepted file types: jpg, jpeg, gif, png, webp.
  • Screening Option #1

    Provide two provider references. Please include names, the time you saw them (no more than 6 months ago), clickable links to their ads or websites, the contact information that they require to give references, your email and phone number you used to contact them and how they will remember you.

    Please do not use Google Voice or any phone number provided by other apps. I will know and will ignore your request for my own safety.

  • Screening Option #2

    If you have no recent companions for references or would like to meet within the same day, I must have a copy of your driver’s license, front and back,. You may hide the address part of the driver’s license, but nothing else.

  • Drop files here or
    Accepted file types: jpg, jpeg, gif, png, webp.
  • Please describe any health problem I should be aware of so I can tailor our session accordingly.
  • I am available from 11am to 12am, Monday to Saturday.

    If I'm available, you may call me at 925-289-9584 with a 3-hour notice only to inquire for same day availability—no chat sessions or texting allowed. I'm able receive but not return international calls.

    For same-day booking, provider references are not accepted as a screening option because references often fail to reply within the same day. For same-day booking, you must submit your driver license as mentioned in "Screening Option Two."

    I will review your request and reply in a timely manner.

    If you try to discuss any illicit act of prostitution then you will be ignored. Discretion is my number one priority and it's also respectful to your Domina.

  • This field is for validation purposes and should be left unchanged.