Name
*
First Name
Last Name
Email Address
*
Nickname to be called
Phone Number
*
Country
(###)
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Age
*
Location (State/Country)
Sex
Marital Status
Sexual Orientation
Height
Weight
Smoker/Non-smoker
How many children?
List of URLs to website, social media profiles, FetLife, etc.
Highest level of education
Occupation/Current Job
Annual Income
Religion
Convicted of a crime?
If yes, what crime(s)?
Are you an extrovert (outgoing) or introvert (shy)?
Do you have a generally positive outlook on life?
Are you slutty?
Please describe yourself as a person and your personality
How do you wish to serve Me?
*
Why do you want to serve Me?
*
What do you seek from Mistress/how do you wish to serve?
What are your needs and desires?
If you're in a current relationship, please describe it
Tell Me your fetishes
*
What are your hard limits?
What are your soft limits?
What commitments do you have that might impact your ability to serve now or in the future?
Do you give Me permission to use pictures/videos from our sessions on My website, social media, or other promotional purposes?
*
Do you currently use drugs?
If yes, which ones and how often?
What recreational drugs have you used if any?
Do you drink alcohol?
If yes, how much and how often?
Allergies, Phobias, Medical Conditions, Physical Limitations
This can be anything from a sensitivity to latex, to depression, history of high blood pressure, etc.
Have you ever been diagnosed with depression, schizophrenia, bipolar, psychosis, anxiety disorders, or neurosis?
If so, did you/are you receiving counseling or treatment?
How do you identify? Check all that apply.
BDSM Experience Level
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Have you ever been owned?
If yes, for how long?
May I contact your last Domme(s) for reference? If yes, provide name and contact
Are you a member of any BDSM clubs or organizations?
Have you/do you attend events, workshops?
Will you accompany Me?
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I like My submissives to accompany Me to fetish parties and other local events, where I can proudly show them off and display their training to My friends. How do you feel about this?
What BDSM books have you read and liked? (Fiction and non-fiction)
Any additional information or questions here
Required Tribute Acknowledgment
*
