Screening Form

Your information

Name*

First Last

Age*

Please enter a number from 20 to 70.

Age*

Untitled

Hidden

Phone*

for screening purposes only

Hidden

Full Name:*

Screening*

How would you like us to verify you?

LinkedIn or company

Provider reference

Screening platform

Client referral

Escort Reference

We accept recent references from high-end independent providers and select agencies.

Escort name*

Escort website*

Contact*

How do you contact them?

By phone

By email

Contact on file*

Hidden

Phone

Hidden

Email

your email:

Client Referral

If an existing client has personally referred you, please ask them to contact us directly to verify the referral and enter their name below.

Name*

Referring clients name

Screening Platform

You may use this method if you are verified on PD, TER whitelisted or have been okay'd by providers on P411.

Select platform*

Please choose one of the platforms below

TER

P411

PD

Your username*

Please send us a message at West Coast Angels on the platform to verify your account after submitting this form.

Submit

If you consent to being contacted once screening is complete, select "Yes". For discretion, please specify the time of day and method which you prefer us to contact you by. We always initiate text with a simple 'hello' and wait for your reply before sending details.

If you do not consent to being contacted, select "No" and reach out to us within 24 - 48 hours.

Email*

required for us to contact you

Phone no.*

required for screening purposes only

Best contact*

Yes, by email

Yes, by text

No

Notes

Any other details you'd like to share

Hidden

Email:

Hidden

Phone:

Comments

This field is for validation purposes and should be left unchanged.

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Your information

Escort Reference

Client Referral

Screening Platform

Submit