CONTACT
Full Name
*
Email
*
Phone
*
Day and preferred time
*
Alternate Time
Preferred length of session
*
Have you been heathy and free of symptoms for the past 2 weeks?
*
*Please share a few words about your intention and what is your reason for seeking me out today? Please share a few short words.
*
Are you a returning patron or a new seeker?
*
Returning Patron
New Seeker
New Seeker:
Your City, State of Residence
*
Where did you find me?
*
What draws you to my practice? How can I support you?
Your board handle or p411/rs2k member details
Choose a screening option.
*
Professional information
Provider references
Professional Information
Link to professional website or Linked-in profile
*
Work Email
*
If company privacy is a concern, kindly email me a photo of your ID to paz@exquisiteoasis.com – I assure you of my discretion.
Provider References:
Provider reference #1:
Provider Name
*
Contact Email
*
Website or current online ad
*
Provider reference #2:
Provider Name
*
Contact Email
*
Website or current online ad
*
Hidden
Finish
Cancellation Policy: I require 1 day notice or a cancellation fee of 50% of your donation amount.
*
I Agree
Email
This field is for validation purposes and should be left unchanged.
WELCOME
By choosing to browse this site you understand and assent that you:
are unoffended by adult material
are at least 21 years old
respect that the contents of this site are copyrighted
release the site owner and any affiliates from any liability that may result from your actions
ENTER
LEAVE