Name (pseudonyms/aliases are fine)
Email (optional)
Phone Number (optional)
Age
Height
Weight
Shoe Size
Please describe yourself physically
How would you describe your sexual orientation?
Have you ever had a domination/submission session before? When, with whom, & where?
How many sessions have you had?
Can you provide references?
What activities have you especially enjoyed during past sessions?
What activities have you experienced during prior sessions that you did not enjoy?
How long have you been interested in BDSM, fetishes, etc?
Please describe your first relevant memory, fantasy, or experience:
Have you experimented w/ BDSM alone or with a significant other? What did you like or dislike?
How did you find My website? How long ago did you find it?
Do you have any prior surgeries or medical conditions which could possibly influence O/our time together? Do you have metal plates or pins,
Please list the conditions that you are currently taking medication for (including aspirin & other over-the- counter medicines):
Do you have any infections or STDs (hepatitis, herpes, staph, Lyme Disease, AIDS, etc.) or come in intimate contact recently with anyone who does?
Do you have any allergies (including foods & latex)? If so, do you carry epinephrine or Benadryl?
Do you suffer from phobias or serious unresolved fears? Do you have any emotional disorders or "triggers" that I should be aware of?
Have you ever have suffered a "bad experience" during BDSM play? Please describe:
If you are into cross-dressing, please describe your desired style or look. List clothing items, accessories, make-up, etc. you desire.
Please list your BDSM interests (i.e. cbt, nt, flogging, roleplay, etc.):
If you are interested in verbal humiliation, please provide a few general examples:
On what areas of the body do you enjoy having pain/sensation administered? Are there any areas I should stay away from?
Can you be marked? Would you say that you "mark easily?"
With 1 being the lightest and 10 being the hardest, state your desired "window" of pain/sensation? What kind?
With 1 being the least and 10 being the most, state the degree of bondage you enjoy? What kind?
With 1 being the least and 10 being the most, state the amount of humilation/degradation you enjoy? What kind?
With 1 being the least and 10 being the most, state the level of submission/worship you enjoy? What kind?
Do you have any fetishes? How long have you indulged them? How much time/money/energy do you devote to them? Do you "buy & purge?"
With 1 being the least and 10 being the most, state the importance of your fetish(es) in relation to the session?
List your favorite movies, songs, television shows, and/or books:
What qualities do you look for in a domina?
Do you enjoy conversation during a session or do you prefer silence?
What are your limits?
Do you have any requests regarding what I wear, make-up, hair, toenails, etc., during the session?
Are you concerned about anonymity/descretion?
Do you have any questions or concerns that need addressed prior to sessioning?
Are there any activities you've never experienced but would like to learn more about?
Is release an important part of the session you desire?
Have you ever had a restraining order filed against you, been charged with stalking, or served time in prison for a violent crime? Please explain:
What caused you to decide to contact Me?
Is there something particular about Me that you find attractive?
Is there anything else I should know?
