Intake Form
Full Name
Email
Phone Number
Birth Date
Gender
Select Gender
Male
Female
Other
Prefer not to say
Do you vape or smoke ?
Select
Yes
No
Body Type
Select Body Type
Athletic
Average
Slim
Overweight
Height
Select Height
>5'
5' to 5' 5"
5' 6" to 6'
Overweight
Sexual Orientation *
Select an option
Straight
Gay
Bi-Sexual
Do you have any STDs ?
Select
Yes
No
Do you have any Tatoos ?
Select
Yes
No
Do you have any piercings ?
Select
Yes
No
Relationship Status *
Select your relationship status
Single
Divorced
Widowed
Legally Separated
Never Married
What is your Nationality?
What country do you currently live in?
Are you willing to move to another country?
Select
Yes
No
Are you willing to travel to see your partner?
Select
Yes
No
Do you have any children/kids?
Select
Yes
No
Please up load 4 photos minimal. At least two different angels of your face and a full body photo. Please do not up load any nude or sexually explicit photos
Submit