Submissive Profile

Please note * in order to submit this form you must enter your private phone number without any spaces or dashes or i will not receive it. thank you ~

Submissive Profile

This area is where you will tell me about your interests, past experiences,limits, and relevant health issues. Please do NOT fill out the application form until you have made a session reservation with me. Personal Info Preference For Day And Time Of The Appointment: (Month/Day/Year) Your Name: Your Email Address: Gender: Male Female Other Age: Telephone Number I Can Reach You At: (No spaces or dashes) In What City and State Do You Reside? Your Physical Description: How did you hear about me? What is your current level of experience? | Novice | 5-10 Sessions | Advanced Why do you wish to session with or serve me in particular? Do you have special skills you would like to mention or offer? Do you have any expectations? Describe your primary interests in BDSM: Describe your favorite fantasy: Describe the kind of session you would like to have with me: Do you have special requests regarding equipment or fetish attire? What is your philosophy or opinion about BDSM? Please select any of the following that apply: You are more responsive to a Mistress who has a demeanor that is: Friendly and Conversational Forceful and Strict Compassionate yet Firm Totally Condescending Abusive and Dismissive Sensual and Seductive Session Dynamic: Seduced/Teased Intense/ Heavy Surprised Forced Natural Torture You would classify yourself as a: Submissive Bottom Masochist Slave Slut/Bitch Victim Patient Other (Please Explain): If you classify yourself as having a submissive, masochistic, slave, bottom mentality, how long have you felt this way? Do you know when your feelings originated? What are your preferred pain level or sensation limits? Not Sure Light Moderate Heavy Extreme Activities & Preferences Bondage, Restraint, Encasement Bondage Types: Vulnerable Bondage Symbolic Bondage Moderate Bondage Predicament Bondage Strenuous Inescapable Immovable Hoods: Latex Leather Cloth Gags: Ball Ring Inflatable Cock-gag Piss-gag Mummification: Partial Complete Bondage Materials: Rope Tape Saran Ace Bandage Vet Wrap Handcuffs Leather Restraints Chain Collars and Leashes Blindfolds Suspension: Partial Full Other Types Of Bondage: Full Body Bondage Cage Cock and Ball Bondage Sensory Deprivation Sensory Overload Vacuum Bed Solitary Confinement Slings Chastity Isolation Abandonment Corporal Punishment Whipping-mild Whipping-moderate Whipping-heavy Whips Floggers Riding Crops Canes Single-tail Spanking: Traditional OTK Soothing and Sensual Corrective Rhythmic Mild Moderate Heavy Spanking Implements: Bare Hand Hairbrush Paddles Slapper Straps Shoes/English Slipper Feminization/Cross-Dressing Light/Partial/Full Transformation Sensual Teasing as a form of humiliation Under Clothes Corset Training Outings or shopping trips Fantasy/Psychodrama Mistress/slave Strict Discipline Domestic Sissy-Slut Maid Service Office Classroom Baby-sitter Mommy Auntie Governess Interrogation Racial Taboo’s Nazi Fantasy Black Plantation Slave Equestrian/Pony Training Dog/Puppy Training Inanimate Object Physical Domination Mind Fuck Nurse-Medical Vampire Cat Woman Age Regression Kidnap-Captive-Abduction Castration (Fantasy ONLY) Objectification Other: Stimulus Spitting Kicking Hair Pulling Face Slapping Teasing Adam & Steve Scenes Dildo Worship Slut Training Strap-on Play Vibrating Toys Cock and Ball Play Cock and Ball Torture Trampling Smothering Foot & Leg Worship High Heel or Boot Worship Golden Showers: Sensual As a form of Humiliation Reward Ingestion Enema Sports Nipple Play Nipple Torture Electrical Play Electrical Torture Water Torture Breath Play: Smothering Choking Strangulation Knife Play Burning Biting Scratching Implements Candle wax Clothes pins/clamps Weights Forks Scalpels Needles Surgical staples Saline injection Catheter Sounds : Vibrating Sounds Urethra Stretching Humiliation Humiliating acts Humiliating talk Verbal abuse – mild Verbal abuse – heavy Exhibitionism Shaming Food mortification Force feeding Forced masturbation Forced ejaculation with penalties Ashtray Reduction What forms of humiliation appeal to you specifically? Mistress Attire Leather Latex PVC Corset Stockings & Garters Nylons Panty Lingerie Business Suit Stiletto Heels with platform without platform no preference Simple Black Dress Formal Wear Fetish Latex Leather PVC Gloves Body Parts Foot & Leg Heels- Shoes Boots Other: Limits NO Pain NO Humiliation or Degradation NO Breaking of the Skin Degree of Marking: None Light Lingering Permanent I mark easily Describe any and all limits that you have: Health Issues Contact lenses or glasses Bad back Joint problems Neck problems High blood pressure Low blood pressure Low blood sugar Bad Knees Hemorrhoids Heart Problems Diabetic Asthma Injury: Have you ever had what you would consider to be a Traumatic Experience? Please explain: Do you have any phobias? Please explain: Are you taking any prescribed medications? Please list prescribed medications you are taking. Are you taking Viagra or other stimulants? List Viagra or other stimulants that you are taking, if any. Do you have any known sexually transmitted diseases (I am tested regularly and suggest that you do the same)? If so, please list them: When was the last time you were tested for sexually transmitted diseases, and what were the results? Contact in case of an emergency? Please list someone you trust and a phone # Additional Comments: Please note: I will not see anyone who is under the influence of alcohol or illegal drugs. If you arrive under the influence I will not conduct the session and I will dismiss you. You will also be charged a walk fee as a result for my time and preparation. Showing up for a session under the influence of alcohol or illegal drugs will also result in banishment.