Contact Lisa Busty

Please provide as much information as possible. Confidentiality is as important to me as it is to you, however, pre-screening is mandatory! Your information here will be emailed to me directly, so you will be notified when i receive it.

This is important-- all the information must be provided otherwise i will not be able to process your appointment form.

*24 hours notice is required for all appointment- please get this form too me sometime the Previous Day- and of course 2 to 3 days in advance is always appreciated.

You must submit this contact info to me or I cannot go forward with your wishes.

For availability, please contact me at:

LisaInLynnwd@aol.com
 
Personal Information:
Full Name: 

 
Age: 
Email: 
Home Phone #: 

 
Job Title: 

 
Ethnicity:
Special Calling Instructions: 

 
   
Appointment Information:
Date: 

 
 

 
Time of Appointment: 

 
How long would you like to spend together?: 

 
Incall or Outcall : 

 

 

 
Where Will We Meet (outcall): 

 
 
Reference:
Provider Reference: 

(please include her name, phone # and website address)
   
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