Part 1 General Information

What is your email address? ex: Mistress@SxySadist.com <mandatory>

What is first name?

Where are you from? (city/state)

Phone/Pager (if pos.):  

Your Age:  

Gender:  
Male Female Cross dresser

Marital Status:  
Married Single but attached Single and free Divorced Widowed Poly-amorous

Sexual Orientation:  
Straight Bi-curious Bi-sexual Gay/lesbian

Health related issues I need to be aware of that may impact our session: (please list past or recent chronic conditions, injuries, disabilities or phobias) Also list any especially sensitive areas:

Please inform me of any emotional issues that you feel may cause a potential trigger or bad reaction: (rape, incest, child abuse, race concerns) or anything that I should be aware of that is a potential problem for you in a scene emotionally. 

Part 2 Scene Basics:

Your preferred power position:   
Submissive / slave Dominant Switch Undecided

Describe your SM experience thus far if any:

If experienced how many years in the scene, or how long interested in it?

What, if any, marks are acceptable to you & for how long?

What do you feel is the most important element in a BDSM scene?

Which choice best describes your interest?
Sensation play Psychological play Both are equally important I just want to serve

Are there any particular areas you feel you would like to challenge explore? 

Please briefly describe what you envision for a first scene with me. I want at least a few sentences in this field or don't bother continuing.

Do you wish to explore service in your submission? If so what kind and how deeply?

What you picture the Mistress wearing.. (be careful, this is a set up question! I don't promise to wear what you ask for and I turn away a lot of people based on inappropriate answers here!)

Part 3 Word Association

This section gives me deeper insight into what makes you tick & turns you on. Please describe at least 3 qualities that you envision when you think of your ideal dominant or submissive. 

Also, please tell me what the first thing that pops into your head when you hear the following terms. Yes, I am an amateur psychologist!  (One or two words is fine)

Power Exchange
Sadist
Masochist
Slave
Master / Mistress
Submission
Domination
Sensual / Erotic
Discipline
Humiliation
Pain

Part 4 Activities Section

Now we get to see what things you want to experience in a session with me. Please choose an interest level beside each activity and then check off any items below that interest you. Also feel free to put a comment, concern or question in the box below any of the categories. Please be as thorough as possible! I like variety A LOT!

Want to briefly describe fantasy scene or share some thoughts?:

Anal & Dildo Play: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Dildo
Fingers
Fisting
Forced Oral
Rape / Gang Bang fantasies
Strap-on
Vibrator
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Asphyxiaphilia & Breath play): No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Lightly restrictive
Moderate restriction
Heavily restrictive
Carotid Pressure
Devices that Restrict
Hoods /gags
Re-breathers (slow O2 deprivation)
Smothering
Suffocation
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Want to briefly describe fantasy scene or share any thoughts?:

Genital Torture (CBT & Pussy torture): No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Light activity
Moderate activity
Heavy activity
Abrasion
Genital Bondage
Clamps / Clothespins
Pressure
Sounds (Urethral)
Weights
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Electro Torture: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Internal PSE Unit
Tens Unit 
Violet Wand
Stun Gun
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Feminization / Cross dressing / Transvestism: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Have clothes I can bring (describe)
Have no clothes need to borrow(list sizes)
Public shopping trips
Maid service /training
Sissy slut training
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Do you have any particular fetishes?
Body Hair  
Body parts
Denim
Feet
Lace
Latex
Leather
Nurse/doctor fetish 
Religious (nun /priest play)
Retifism (shoes or boots) 
Rubber
Scents / smell(what kind?)
Other or please give more detail to above choices: 

Foot & leg worship: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Would like some in the scene, but none main focus
Wants a moderate amount in the scene
My main interest in the scene
Altocalciphilia (love of high heels)
Bare feet
Boots
Enjoys kissing /licking feet /legs 
Gives a good foot massage
Stocking feet  
Pantyhose
Trampling
Willing to learn to give pedicure
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Heat & Fire Play: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Alcohol lighting
Branding 
Candle wax
Cigarette /incense torture
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Humiliation:  No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Mild level
Moderate level
Heavy level
Being spit on
Collar & Leash
Crawling
Face slapping
Feminization
Hair Pulling
Kneeling 
Public Display
Used as an object (table, foot rest, ashtray etc) 
Verbal Degradation
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Nipple Torture:  No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Light activity
Moderate activity
Heavy activity
Abrasion
Breast torture/ nipple bondage
Clamps / Clothespins
Nibbling / Biting
Stretching
Weights
Other: 

Want to briefly describe fantasy scene or share any thoughts?:

Percussion Play: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Light activity
Moderate activity
Heavy activity
Spanking
Floggers
Whips (single tails)
Paddles
OTK (over the knee)
Canes
Crops
Other: 

Sensations that I enjoy or think that I might enjoy most:
Thuddy/Thumpy
Stingy/Sharp
Combinations or variety of sensations

Materials I enjoy or think I would enjoy: 
Deerskin
Leather
Nylon
Rattan
Rubber
Synthetics
Wood
Other: 
Corporal play com or fantasy:

Piercing / Suturing/ Cutting:  No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Acucullophallia (being cut)
Beading (body adornment)
Blood Play
Lacing(wrapping string around the needles for bondage)
Suturing
Temporary Piercing
Have permanent piercings (list)
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Room/Furniture preferred:
Cross-dressing Parlor
Medical Office /Exam room
Medieval torture room /Dungeon
Sensory deprivation cave
Cross
Cage
Swing
Corporal bench
Bondage /Exam table
Bondage chair
Rack
Other: Comment?:

Sensation Play:  No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Cupping (suction of the skin)
Feathers
Fur
Ice 
Light /soft flogging
Mild abrasion /scratching
Tickle torture
Other:

Want to briefly describe fantasy scene or share any thoughts?:

Sensory Deprivation: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Audio/Video Stimulation
Blindfolds
Ear Plugs/headphones
Gags
Gas Masks 
Hoods
Long periods of bondage

Other:

Want to briefly describe fantasy scene or share any thoughts?:

Toilet Play: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
Catheters
Coprophilia (shit play)
Klismaphilia (douching/enema)
Rimming
Urolagnia (watersports aka golden showers)
Other:

Want to briefly describe fantasy scene or share some thoughts?:

Miscellaneous: No exp & not interested at all No exp & somewhat curious No exp & very curious Have exp & dislike it Have exp & like somewhat Have exp & like it alot Have exp & love it
24/7 (Total Power Exchange)
Algolagnia (love of pain)
Autoerotica (masturbation)
Dacryphilia (arousal from tears)
Exhibitionism
Other: 

Want to briefly describe fantasy scene or share e thoughts?:

Referral and Web site commentary: How did you hear about me? Where did you find my web link etc? (Domme board, banner link other?) 

Any comments or suggestions about the web site? Ease of navigation, ambiance, loading speed, pic quality etc? 


Mailing List: I have a newsletter that is sent on average 4 times a year, that generally has information on my travel sessions, events I am attending, classes I am teaching, new and exciting things added to my dungeon, session promotions, private invitation only parties and other things I deem newsworthy. This list is NEVER shared with anyone else. Do you wish to be on my list? (Please not: if you leave this blank I will add you by default)

Please read this last bit and initial the bottom. 
"I understand that the answers to this questionnaire are to be used only to plan a BDSM session. My limits will be respected and I may stop the scene at any time I wish. I understand that the Mistress is a skilled professional and that care and caution is taken to insure my safety, but I acknowledge that there is inherent risk to BDSM play. I further understand that there will be NO sex of any kind, NO illegal activities permitted, and NO nudity on the part of the Mistress." 
Initials:

Finally, did thinking about and picturing all of these things while filling out the form excite you just a little? (Any last words?)

Ok great and thank you for your efforts! Once you hit "Submit the completed form will be automatically mailed to me at Mistress@SxySadist.com.

I should respond to you within 48 hours with more information or further instructions. If however I do not it may mean I am away for a few days. I answer all email that I receive one way or the other. If you do not hear from me within 72 hours you may wish to send a follow up email in case your email was lost in cyber space. Best Wishes!! SxySadist