New Client Screening Form Please submit REAL & HONEST answers. For my safety, I do my due diligence to screen all new clients. Name (as it appears on your Driver License) Age & Race Personal cell number that is registered in your name Hobby cell number Board Handles Appointment Date & Time Request Appointment Length Appointment City Where did you hear about me? Employer Company Name Employer Company Website Your Occupation Employer's Main Contact Number Your Work Phone Number Your Work Email Provide 2 active social media handles By selecting "I AGREE" you are acknowledging that you have read, understand, agree and will adhere to my policies regarding privacy and cancellation fees in ANY event that you have to cancel more than 12 hours after I have confirmed our meeting time. - Select -I AGREESubmit