• 1. Any BDsM Scene Experience?


    • ___Yes  ___No 


  • 2. Sexual Peferences:

    ___male  ___female  ___transexual  ___heterosexual 

    ___bicurious  ___bisexual  ___gay 

  • 3.  Dominant?

    ___always ___often ___rarely ___never

  • 4.  Submissive?

    • ___always ___often ___rarely  ___never

  • 5.  Masochistic?

    ___very ___somewhat ___hardly ___no way

  • 6.  Sadistic?

    ___very ___somewhat ___hardly ___no way

  • 7.  My Main Interests Are?

    ___Dominant Or submissive Role play)

    ___Sensual Or Physical

    ___Visual Or Aural

  • 8.  I Am Willing To Play At?

    ___Anywhere my Dominant Chooses

    ___at SM clubs

    ___At SM Play Parties

    ___In Public Far From my Home

    ___In Public Near my Home

    ___In my Home

    ___Outdoors

    ___other: ___________________


  • 9.  Who Has Information About Your Activities?

    ___I Am Extremely Discreet, Keep It Between Us.

    ___A Few Of my Very Trusted Friends.

    ___Others In The BDsM Communities.

    ___My D/s Side Is Obvious...Don't Care Who Knows.

  • 10.  Playing With Others?

    ___Play Only With my Dominant.

    ___Threesomes Are Acceptable. (as Long As my Dominant Is Present)

    ___Small Group Settings Are Acceptable.

  • 11. About Punishments:

    ___It Is my Dominants Right.

    ___It Enhances The Fantasy.

  • 12. Visual Markings.

    ___my Body Should Remain Free Of Visible Markings.

    ___A Little Redness Or Slight Welping Is Acceptable.

    ___Accidental Or Light Bruises Are Acceptable.

    ___i Wear my Marks Like A Badge Of Honour.

    ___i Prefer To Be Marked Such As Tattoos, Brandings Or Piercings.



  •  List Any Medical Conditions Or Health Factors.

    ____________________________________________________________

    ____________________________________________________________

  • These Words Or Actions Are A Turn Off:

    ______________________________________________________________

    ______________________________________________________________

  • Things That Make me Feel Loved, Excited & Adored:

    ______________________________________________________________

    ______________________________________________________________

  • What Positions Have The Highest Erotic Value For You?

    _____Standing Bondage

    _____Lying On Back

    _____Lying Face Down Or Cheek To The Floor

    _____Kneeling

    _____Hands & Knees

    _____Other


  • ROLE PLAYING

    • Your Experiences Or What You May Or May Not Enjoy Participating In.

    ____ Amazon / Barbarian

    ____ Bitch-Goddess

    ____ Boss / Employee

    ____ Burglar / Victim

    ____ Child / Caretaker

    ____ Clergy / Nun

    ____ Cowboy/girl / Indian

    ____ Daddy / Mommy/ Lil Girl

    ____ Doctor / Nurse / Patient

    ____ Fantasy Rape

    ____ French Maid

    ____ Hero / Femme Fatale

    ____ Interrogator / Prisoner

    ____ Kidnapper / Victim

    ____ Knight / Princess

    ____ Master / Pet

    ____ Pimp / Hooker

    ____ Pirate

    ____ Policeman / Fireman / Suspect

    ____ Ponygirl

    ____ Principal / Teacher / Student



  • Sexual Information

    • Your Experiences Or What You May Or May Not Enjoy Participating In.

    ____ Anal Fisting

    ____ Anal penetration

    ____ Anal penetration

    ____ Analingus

    ____ Cock worship

    ____ Cunnilingus

    ____ Mechanical Penetration

    ____ Forced Masturbation

    ____ Double Penetration (Vaginal/Anal)

    ____ Cum Fetish (Your Cum Or Someone Elses)

    ____ Strap-ons

    ____ Vaginal Fisting

    ____ Vaginal Penetration


  • BONDAGE

    • What Is The Degree Of Immobility Or Helplessness You Find Acceptable?

    ___ SLIGHT ___ MODERATE ___ EXTREME

    ____ Body Bag

    ____ Breast Bondage

    ____ Chains

    ____ Collars

    ____ Cotton Rope

    ____ Crosses

    ____ Cuffs

    ____ Duct Tape

    ____ Gags

    ____ Genital Bondage

    ____ Harnessing

    ____ Holding Position

    ____ Hoods

    ____ Mummification

    ____ Put In A Cage

    ____ Saran Wrapping

    ____ Shackles

    ____ Silk Scarves

    ____ Slings / Swings

    ____ Spreader-bars

    ____ Stocks

    ____ Straight-jackets

    ____ Strapping - full body




  • Fetish:

    • ____ Breath Control

    ____ Catheterization

    ____ Enemas

    ____ Physical Examinations

    ____ Golden showers

    ____ Medical scenes

    ____Electro Play

  • The Toys & Stimulations:

    • ____ Abrasions (HairBrush Bristles, Sandpaper, etc..)

    ____ Belt / Straps

    ____ Biting

    ____ Branding

    ____ Cane

    ____ Clips and Clamps

    ____ Cock & Ball Torture

    ____ Clit Torture

    ____ Electrical Play

    ____ Heat

    ____ Hot Wax

    ____ Knotted Whips

    ____ Leather Paddle

    ____ Needles (Piercings)

    ____ Pinching

    ____ Riding Crop

    ____ Spankings (Including Over The Knee)

    ____ Water Torture

    ____ Blindfolds

    ____ Clothespins

    ____ Cock Rings

    ____ Dildoes

    ____ Feathers / Fur

    ____ Handcuffs

    ____ Oils / Lotions

    ____ Vibrators

    ____ Weights