* indicates required field.
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):
Preferred session start time:
Length of session*:
Which of the following roles do you identify with?
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):
Any further questions or comments:
Do you agree you are a consenting adult over the age of 21?*
Do you understand there is absolutely no sex offered or implied?*