Minimum 24 hours advance notice is highly recommended and appreciated to ensure my availability. Travels outside of the US require at least 5 days notice. Thank you.

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Please, for first time meetings, you will have to fill up my reservation form .I guarantee 100% confidentiality as mutual respect concerning the same is always desired. Once you have been screened I will make a final comfirmation by phone to you in order to firm up last details before our meeting and provide you with my private number at which I can be reached. If you have any other questions please email me at ..........

NOTE:

First Name:
Last Name:
Age:
City/State of Residence:
Zip code:
Contact Number/Cell Phone:
Your E-mail:

Company/Business Name:
Your Position:
Company Main Number:
Your Business Extention:
How should i greet you when calling your office?
Provider Reference:
How Did You Find Me?

Desired Appointment Date:
Desired Appointment Time:
Duration of Appointment:	Please select the desired duration 2hr 4hr 6hr 12hr 24hr

Your Comments/Special Requests: