Please take a moment to fill out the form in its entirety. All information requested is completely confidential, never shared, and will be purged once we have an ongoing, working relationship.

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Screening is mandatory and of the utmost importance, both for my safety and yours. I will ask for a tangible picture ID upon arrival.

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No exceptions!

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• SummerSegal@Protonmail.com

• 415-483-5699