| Name*: |
|
| Email Address* (I prefer all initial contact via email. We will have a chance to speak over the phone once our session time is confirmed): |
|
| Age* (if you are under the age of 21 you will not be able to book a session): |
|
| Days of the week you are available* (mark all that apply): |
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
|
| Preferred session start time (note: I generally session in San Francisco during the evening hours only): |
11am-3pm
3pm-6pm
6pm-9pm
9pm-later
|
| Length of session*: |
|
| Preferred location*: |
|
| Which of the following roles do you identify with? |
adult baby
cross dresser
fetishist
masochist
pet
sissy
slave
submissive
other
|
| What are your major fetishes? |
|
| What are your favorite activities/interests?* |
|
| What are your limits/boundaries?* |
|
| Do you have any new activities you are interested in exploring? If so, elaborate. |
|
| List any medical conditions I need to be aware of: |
|
| Describe your past experience with BDSM: |
|
| Provide two verifiable references from previous providers; include their name, e-mail address, and website address. If this is your first time contacting a Mistress, write "new submissive" in the text box*: |
|
| Tone of session (mark all that apply): |
playful
sensual
strict
forceful
|
| Any further questions or comments: |
|
| Do you agree you are a consenting adult over the age of 21?* |
yes
no
|
| Do you understand there is absolutely no sex offered or implied?* |
yes
no
|
|
