Request a date.

If we haven’t met yet, filling out this form will give me all the info needed to screen you as a safety measure, and to find time in our calendars. The more thorough you are in filling this out, the sooner we’ll be able to meet!

Please send: Full name, phone number (no burners), email from your place of work, and LinkedIn. I have an unlisted email which you may use for discretionary purposes, simply request that address in your message on the inquiry form. Once I receive your completed booking form, I will be in touch with any additional information that may be needed to complete screening.

Discretion is paramount, I delete all personal information after we have met.

If you prefer to not submit your screening information via the form on my website, you may send the required screening information to me directly via email at EmilyEast@protonmail.com

Looking forward to meeting you…

Emily xoxo

Legal name

First Name

Last Name

Phone

(###)

###

####

Preferred method of contact

Please let me know how you prefer that I contact you, so that I know how to reach out to you after you have completed this form. I respect your privacy and understand that some communications must be handled with the utmost discretion. I will only contact you via the method that you have given me permission to do so (i.e. "Please only contact me via email at xxxx@xxxx.com", or, "Please only contact me via text or call at this number xxx-xxx-xxxx", etc.).

Occupation

Optional

When would you like to meet me?

Please provide an approximate date you would like to get together. Additional details may be provided in the message box if needed.

YYYY

What time would you like to meet?

Please provide an approximate time you would like to get together. Additional details may be provided in the message box if needed.

Hour

Minute

Second

Duration

Your place or mine?

Message

Tell me a little about yourself or leave me a love note! xoxo