Name:
Date: Email Address (optional):
Weight: Height:
Shoe Size:
Age:
Phone Number (optional):
Please describe yourself physically:
Have you ever had a professional domination/submission session before? With whom & where?
How many professional BDSM sessions have you had (total)?
What activities did you especially enjoy during prior sessions?
What activities have you experienced during prior sessions that you did not enjoy?
How long have you been interested in BDSM, fetishes, etc?
If you've never had a professional domination session, have you experimented w/ BDSM alone or with a partner?
How did you find Me? www.eros.com
www.pandemos.net
google search
www.maxfisch.com
www.dickievirgin.com
www.americandoms.com
www.bellaslist.com DDI domina.ms
www.seriousmistress.com www.your-mistress.com www.domme-list.com
www.fetbot.com
Did you find Me thru a link on another Mistress's Site? Whose? Other (Please Explain)
Do you have any prior surgeries, medical conditions, phobias, past history, etc., which could possibly influence O/our time together?
Do you have metal plates or pins, a pacemaker, insulin pump, or other electrically operated device?
Do you have a history of heart disease, nerve damage, diabetes, high blood pressure, or hemophilia?
Do you have a blood clotting disorder, a vascular disorder, or a seizure disorder?
Do you have Hepatitis, Lyme disease, Herpes, or HIV?
Are you allergic to latex?
Do you have any other allergies?
corporal
What are your primary interests? bondage nt cbt
gags
electrical humiliation role play
spitting cross dressing
fetish
sounds teasing & denial cupping slut training
maid service
foot worship
suspension
verbal abuse
trampling abrasion ball kicking
blindfolds
play piercing sensation play small penis humilation
cuckholding
spanking
other (please explain):
Please describe the session you desire in as much detail as possible:
What activites do you not want included in the session under any circumstances?
How do you feel about marking/bruising?
Are there any activites you've never experienced but would like to learn more about?
Do you have any questions or concerns that need addressed prior to sessioning?
Is release an important part of the session you desire?
If you desire verbal humiliation, dirty talk, etc., please write a few phrases typical of what you like to hear/be told.
Do you have any requests concerning what your Mistress wears during the session? How important is it that She wear this particular item(s)?
Is there anything else I should know?