- Roles
- Who will be dominant?
- Who will be submissive?
- Type of scene:
-
- Mistress/Slave
- Captive
- Servant/Butler/Etc
- Cross-dressing/gender play
- Age play
- Animal play
- Other
- Any chance of switching roles?
- Place
-
Location
- Who will ensure privacy?
- Time
-
Begin at:
- Lenth:
- Beginning signal:
- Ending signal:
- Who will keep track of time?
- Obedience
-
Will submissive promptly obey?
- May the dominant "overpower" or "force" the submissive?
- May the submissive verbally resist?
- May the submissive physically resist?
- May the submissive try to "turn the tables"?
- Does the submissive agree to wear a collar?
- The submissive agress to address the dominant by the following titles:
- Limits
-
Submissive's limits
- Submissive's physical/emotional/SM activity limits:
Any problems with the submissive's:
-
Heart
- Liver
- Lungs
- Neck/Back/Bones/Joints
- Kidneys
- Nervous System/Mental
- Explanation
- Is the submissive wearing contact lenses?
- Does the submissive have implanted pace maker?
- Does the submissive have any metal plates implanted?
- Drug Metering Pumps?
- Does the submissive have a history of....
-
Seizures
- Dizzy Spells
- Diabetes
- Hypoglycemia
- Seizures Disorders
- Known Brain Wave Abnormalities
-
High Blood Pressure
- Fainting
- Asthma
- Heart Rhythm Oddities
- Hyperventilation attacks
- Describe any phobias:
- Submissive's medical conditions:
Any surgical implants (breast, face, etc?)
- Is the submissive taking asprin?
- Is the submissive taking ibuprofin, Motrin, or other non-steroidal,
anti-infammatory drugs?
- Is the submissive taking antihistamines?
- Other medications submissive is taking:
Allergic to; - Bandage tape:
- Nonoxynol-9
- Other allergies:
- In case of emergency notify:
- Dominant's Limits
- Any problems with the dominant's:
- Heart-
- Liver
- Lungs
- Neck/Back Injuries
- Bones/Joints Kidneys
- Nervous System/Mental-
- Heart Rhythm Oddities-
- Seizure Disorders
- Implanted Pace Maker-
- Drug Metering Pumps-
- Does the Dominant have any metal implants?
- Known Brain Wave Abnormalities-
- Dominant's other medical conditions:
- Medications dominant is taking:
- Is the dominant currently certified in First Aid and CPR-
- Safety gear on hand: Paramedic scissors:
- Fire extinguisher:
- First Aid Kit:
- Blackout lights:
- Flashlight:
- Will play take place in an isolated area such as a farmhouse
or other location?:
- If yes, what precautions will ensure the submissive's safety if
the dominate becomes unconscious?
- . Sex
- Are you Male?
- Are you Female?
- Are you a TS?
- if yes- pre-op
- post-op
- Age:
- Marital/Relationship Status:
- Monogamus:
- Sneaking behind partners back:
- Polyamory:
- Occupation:
- Height:
- Weight:
- Hair Color:
- Eye Color:
- Facial Hair?
- Charactistics (things you'd like known about you, physically):
- Does any participant beleive they might have a trichomonas or yeast infection
- Does any participant believe they might have herpes?
- Does any participant believe they might have any STD?
- Does any participant believe they might have Hepititis?
- Have participant been tested for HIV?
- Been tested positive?
- Check off which of the following sexual acts are acceptable:
- Masturbation
- Dominant to Submissive
- Submissive to Dominant
- Fellatio
- Dominant to Submissive
- Submissive to Dominant
- Cunnilingus
- Dominant to Submissive
- Submissive to Dominant
- Rimming
- Dominant to Submissive
- Submissive to Dominant
- Anal Fisting
- Dominant to Submissive
- Submissive to Dominant
- Vaginal Fisting
- Dominant to Submissive
- Submissive to Dominant
- Vaginal intercourse
- Dominant to Submissive
- Submissive to Dominant
- Anal intercourse
- Dominant to Submissive
- Submissive to Dominant
- Is swallowing of semen acceptable
- Will any sex toys such as vibrators, dildoes, butt plugs, ben wa balls, etc
be used?
- Describe:
- Which of the above activities will involve birth control pills,
diaphragms, spermicidal suppositories, lubricants containing nonoxynol-9, or
contraceptive foam/suppositoried/gel?
- Which of the above activities will involve condoms, gloves, dental damns,
and/or other barriers?
- Intoxicants
- The dominant can use (only) the following intoxicants during the session:
- The submissive can use (Only) the following intoxicants during the session:
- Bondage
- The submissive agress to allow (only) the following types of bondage:
- Hands in front
- Hands behind
- Ankles
- Knees
- Elbows
- Wrists to ankles(hog-tie)
- Spreader bars:
- Tied to Chair
- Tied to bed
- Use of blindfold
- Use of gag
- Use of hood
- Use of rope
- Use of handcuffs/metal restraints
- Use of tape
- Use of leather cuffs
- Suspension
- Acceptable degree of immobility/helplessness:
- Limited
- Moderate
- Extreme
- Explanation
- Pain
- Submissive's general attitude about receiving pain:
- Likes
- Accepts
- Neutral
- Dislikes
- Will not accept
- Quantity of pain submissive wants to receive:
- None
- Small
- Average
- Large
- Explanation:
- Dominant's general attutude about giving pain:
- Quantity of pain dominants wants to give:
- None
- Small
- Average
- Large
- Explanation:
- The following tyoes of pain are acceptable:
- Spanking
- Paddling
- Whipping
- Caning
- Face slaps
- Biting
- Nipple clamps
- Gential clamps
- Clamps elsewhere
- Hot creams
- Ice
- Hot Wax
- Other types/methods of pain:
- Additional remarks:
- Marks
- Is it acceptable to the submissive if the play leaves marks?
- Visible while wearing street clothes?
- Visible while wearing a bathing suit?
- Other:
- Is it acceptable to the submissive if the play draws small amounts
of blood?
- How easy of difficult has it been to mark the submissive in the past?
- Erotic Humiliation
- The submissive agrees to accept being referred to by the following terms:
- The submissive agress to the following forms of erotic humiliation:
- "Verbal abuse"
- Enemas
- Spitting
- Water Sports
- Scat games
- Other:
- Any prior really good or really bad experiences in these areas?
- Safe Words
- Safe Words #1 and its meaning
- Safe word #2 and its meaning
- Safe word #3 and its meaning
- Non-verbal safe words and their meaning
- Will "two-squeezes" be used?
- Opportunities/Special Skills
- Anything in particular either party would like to try and explore?
- Dominant
- Which statement best suits you:
- I live D/s lifestyle every day in most activities:
- I live D/s lifestyle frequently when in relationship:
- I live D/s lifestyle occasionally in relationship:
- I live D/s lifestyle in "scenes" or "play" only:
- I use D/s only in "scenes" or "play":
- I do not live D/s lifestyle but would with correct sub:
- I would not live D/s lifestyle but would use for "play" with correct sub
- (Other statement which best suits you):
- Are you interested in:
- On-Line Relationship ONLY:
- On-Line/Phone Relationship ONLY:
- Real Time Relationship ONLY:
- On-Line/Phone/Real Time Relationship Combination:
- Do you currently have a sub/slave:
- Are you currently seeking a sub/slave:
- Would you take on "multiple subs":
- Can or would you travel to meet/be with a sub:
- Would you have a sub travel to meet you:
- Are you experienced with:
- On-Line D/s:
- Phone D/s:
- Real Time D/s:
- Previous Relationships:
- Have you ever had a "collared" sub:
- On-Line Only:
- Real Time:
- (Why did that relationship terminate, current relationship with that sub
- D/s SOCIAL:
- Would you expect a sub to perform the following and if so, how often:
(Rating scale: "O" (occasionally). "F" (frequently). "A" (at all times when applicable).
- Kneeling (clothed):
- Kneeling (naked):
- Wearing bondage outside "scenes" (crotch ropes, etc.):
- Wearing toys outside "scenes" (nipple clamps, etc.):
- Wearing toys/bondage in public:
- "Correct posture" outside "scenes" (define):
- Sexual situations in public:
- Wearing D/s collar in public:
- Wearing D/s collar in private:
- Performing "instructions" (delivered on-line or phone):
- Would you require a standard form of dress for the sub in private (if so,
what):
- Would you require a standard form of dress for the sub in public (if so, what):
- What form of address would you expect from the sub for youself and others (check applicable):
- Yourself:
- Sir:
- Master:
- First name:
- Mr. (last name):
- Mistress
- Ma'am
- Domina
- First Name
- Ms
- Ms (last name)
- Other Males:
- Other Females:
- Both Dom/Dommes and subs...in and out of BDSM
- What aspects of your subs' life would you want to control (check all appl=
icable):
- Choice of clothing:
- Choice of food:
- Daily activities:
- Special occasion activities (non-sexual):
- Sexual activities:
- Social contacts:
- Sleeping hours:
- Bathing/toilet rituals:
- Business/professional life:
- Would you desire to "share" your sub with others:
(If "YES", state the circumstances and likely other partners)
- Would you wish your sub to have any of the following (check applicable):
- Tattoo of ownership:
- Branding of ownership:
- Collar (or bracelet) worn constantly:
- Screen name change to reflect ownership:
- List any "scene" or "play" activities which you WOULD NOT DO under any circumstances:
- PUNISHMENTS:
What forms of punishments would you use on a disobedient sub:
- Writing assignments:
- Meditation:
- Corporal Punishment (spanking, whipping, etc.):
- Bondage (any form):
- Removal of privilages:
- Loss of Contact with you:
- Withholding orgasms/pleasure:
- Other (please state):
- REWARDS:
- What forms of rewards would you give a pleasing sub:
- Small "presents" (flowers, etc.):
- Extra privilages:
- Additional "play":
- Personal momentos (inc. letters to her, etc.):
- More about you:
- Non-D/s Interests/Hobbies:
- Favorite Music Types:
- Favorite Reading:
- Favorite Non-D/s Leisure Time Activities:
- Any other information you would like to supply regarding yourself:
- Submissive
- Which statement best suits you:
- I live D/s lifestyle every day in most activities:
- I live D/s lifestyle frequently when in relationship:
- I live D/s lifestyle occasionally in relationship:
- I live D/s lifestyle in "scenes" or "play" only:
- I use D/s only in "scenes" or "play":
- I do not live D/s lifestyle but would with correct Dom:
- I would not live D/s lifestyle but would use for "play" with correct
Dominant:
- (Other statement which best suits you):
- Are you interested in:
- On-Line Relationship ONLY:
- On-Line/Phone Relationship ONLY:
- Real Time Relationship ONLY:
- On-Line/Phone/Real Time Relationship Combination:
- Do you currently have a Dom/Top/Owner:
- Are you currently seeking a Dom/Top/Owner:
- Can or would you travel to meet/be with a Dominant:
- Are you experienced with:
- On-Line D/s:
- Phone D/s:
- Real Time D/s:
- Previous Relationships:
- Have you ever been collared?
- Why did that relationship terminate? Whats your current relationship
- with that Dominant?
- Have you had previous relationships:
- What aspects of your life would you want your Dominant to control (check all
the apply)
- Choice of clothing:
- Choice of food:
- Daily activities:
- Special occasion activities (non-sexual):
- Sexual activities:
- Social contacts:
- Sleeping hours:
- Bathing/toilet rituals:
- Business/professional life:
- Would you desire to be "share" with others:
- Shared with:
- Female Dominates:
- Female submissives:
- Male Dominants:
- Male submissives:
- Would you have any of the following done for your Dominant:
Check those that apply
- Tattoo of ownership:
- Branding of ownership:
- Collar (or bracelet) worn constantly:
- Screen name change to reflect ownership:
- List any "scene" or "play" activities which you WOULD NOT DO under any circumstances:
- More about you:
- Non-D/s Interests/Hobbies:
- Favorite Music Types:
- Favorite Reading:
- Favorite Non-D/s Leisure Time Activities:
- Any other information you would like to supply regarding yourself:
- Follow-Up
After the session we need a coming down period
The next day we should discuss how things went
A week later follow-up
In case of crisis:
18. Anything Else?
Post-session notes:
- Dominant
- Best Part 1-10 scale(ten tops)
- Worst Part 1-10
- Most memorable part 1-10
- Other comments:
- Submissive
- Best part 1-10
- Worst Part 1-10
- Most memorable 1-10
- Other comments
|