EmailMe Form - Questionnaire for Miss Jay*

First name and last initial are required *

First Last

What State do you live in? *

Age? (You must be over 21) *

Phone number is required *

### - ### - ####

Please verify the last 4 of your phone number: *

Email Address *

Confirm Email

What location do you prefer? *

Where did you hear about Miss Jay? *

Are you a : *

Brand New Client

Existing Client

Just doing some research

Contact: Check all that apply.

I agree to be contacted using: *

Text

Phone Call

Email

Best time to contact me is: *

Before Noon

Before 5pm

After 5pm

Session Request:

Session with?

Length of session? *

Availability: Choose three dates/times you are available.

1st Choice: *

MM / DD / YYYY

What time of day? *

2nd Choice:

MM / DD / YYYY

What time of day?

3rd Choice:

MM / DD / YYYY

What time of day?

Interests: Check up to 5 things that you are interested in exploring.

NEW SPECIAL SESSIONS! Check here for more information

Cuddling

Fitness / Diet

Savings / Financial Wellness

De-cluttering

Please tell me a little about what type of session you are imagining / dreaming of:

LEGAL DISCLAIMER: By filling out this form I agree that I have read and understand the limits, rules and boundaries that Miss Jay has set. No sexual services are offered. Any requests (in person or in a message) for activities that are listed as hard limits will not be tolerated. It is disrespectful and will get you blocked. Limits can be found here:(Recovered)

https://yesmissjay.wixsite.com/missjay/limits

NEXT STEP: Once you click the submit button you will be directed to the confirmation page where instructions and a phone number will be provided. (TEXT ONLY)

Covid status: *

I am vaccinated

I am not vaccinated