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Contact 
ME

Whether internationally or in Canada, you can fill out the contact form below to request an appointment with me.

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Phone

E-mail

1(647)-688-3962

chanellsmith@protonmail.com

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Based &
Located
 

TORONTO, ON

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Interested in booking
an appointment
With ME ?

If you are interested in booking an appointment with me, please fill out the form below.

Please note that not all information is obligatory, however for screening purposes it will make booking our date that much easier! All information is kept strictly confidential and will not be shared.

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Screening &
Request form

BASIC INFORMATION


Please complete the form below.


Please list the name and contact information from two past providers.

REFERENCE #2


Please list the name and contact information from two past providers.

BOOKING INFORMATION


Please complete the social date information below

Preferred time

Please describe your ideal social date, include any specials request below.

ADDITIONAL INFORMATION

Please complete the additional information below

Please briefly introduce yourself and leave any other information you might want me to know about you. 

Thank you for your sending!

REFERENCE #1

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