I won't ask you to fill this out until I feel it is appropriate,
although if you wish to begin with it, that is fine/
(I have no intention of assuming a dominant posture,
and ordering it's completion until I feel a certain measure
of trust and communication has been established)
Be aware though that if we establish a correspondance,
I will request this at some point soon in the process.
Please fill this out only if you are willing to answer
completely honestly, and in full detail (no vague, evasive, or blank answers!)
This is a long questionnare. It will take some time and
some thought to complete it. Your willingness to do so will
demonstrate to me a commited interest in getting to know
one another.
Your compliance will result in receipt of my answers to a similar questionnare.
Age / Birthday:
Height:
Weight:
Eye Color:
Hair Color/Type/Style:
Tattoos/Piercings (describe):
Pubic hair :
Medical, Physical or Emotional Concerns? Chronic Conditions? Allergies? :
- Natural
- Trimmed
- Shaved
Other Characteristics (things you'd like known about you, physically):
Occupation and Annual Income :
How long in this position? (send a full resume, if possible) :
Importance of Your Career in Your Life :
Living Conditions:
Marital status :
Religious Beliefs :
Political Inclinations :
Non-D/s Interests/Hobbies/Leisure Time Activities:
Favorite Music Types:
Favorite Reading:
Do You Smoke/Have Ever Smoked Cigarettes:
Do You Smoke/Have Ever Smoked Marijuana (how often):
Do You Use / Ever Have Used Illegal Drugs (what/when/how often): ften)
Do You Drink Alcohol (never, rarely, "socially", a lot - describe) :
Dietary Habits (meat eater, "white meat only", lacto-ovo-vegetarian, vegan):
Do You Exercise (describe):
Number of Previous Sexual Partners:
Age at Loss of Virginity:
Have You Ever Had an STD (describe):
Have You Ever Had an Abortion (how many):
Have You Ever Been Sexually Abused/Raped (describe):
Pro-Life or Pro-Choice? :
Preferred Method of Avoidance of STDs / Pregnancy :
Financial Situation? Good/Bad Credit Record? :
Have You Ever Been Convicted of a Crime :
Do You Desire Children, If So How Many:
Do You Desire to Maintain a Professional Career :
How Do You Feel About The Traditional Role of Homemaker and HouseWife :
List Your Concerns About the Depth and Exclusivity of a Relationship: :
Are You Interested in:Read the following page about types of submissives, and describe which you think you are. Do you aspire to be something more? What do you think you are capable of?
Do you currently have a Dom/Master:On-Line Relationship ONLY: On-Line/Phone Relationship ONLY: Real Time Relationship ONLY: On-Line/Phone/Real Time Combination:
Are you currently seeking a Dom/Master:
Do you have 'mentor' Dom/Master :
What are your feelings about "multiple subs":
Would you travel to meet a Dom :
Would you have a Dom travel to meet you:
Are you experienced with:
Have You Ever Been a "Collared" Sub:On-Line D/s: Phone D/s: Real Time D/s:
On-Line Only: Real Time: Why did that relationship terminate, current relationship with that Dom:
Rating scale:
"O" (occasionally).Would you prefer a standard form of dress in private (if so, what):
"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" : 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 prefer a standard form of dress in public (if so, what):
What aspects of your life would you be willing to offer control of to your master (check all applicable):
What forms of punishments would be appropriate for you:
- 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:
- Writing assignments:
- Meditation:
- Corporal Punishment (spanking, whipping, etc.):
- Bondage (any form):
- Removal of privileges:
- Loss of Contact with dom:
- Withholding of orgasms/pleasure:
- Other (state):
Experience rating scale:
0 - never tried it.Willingness rating scale:
1 - tried it once.
2 - tried a few times.
3 - basic knowledge and experience.
4 - proficient/advanced.
5 - use in most or all "scenes"
NO means you will NOT do that item under any circumstances (a hard limit).
0 (zero) indicates you have utterly no desire to do that activity and don't like doing it (in fact, may loath it) and would ordinarily object to doing it, but you would be willing to do it to please the Dominant if it they really wanted it. (sometimes called a "soft limit").
1 means you don't want to do or like to do this activity, but wouldn't object if it was asked of you.
2 means you are willing to do this activity, but it has no special appeal for you.
3 means you usually like doing this activity, at least on an irregular/ occasional basis.
4 means you like doing this activity, and would like to experience it on a regular basis.
5 means the activity is a wild turn-on for you, and you would like it as often as possible.
Mark with an asterisk (*) those items which you are willing
to do only with you current sex partner(s), but not with casual play-partners.
Note any additional information which might be important for your Dom to
know.
There is intentionally some overlap between categories.
Unless otherwise stated, the Sub is the recipient of the activity.
Be SURE to fill out BOTH the Experience and Willingness columns!
| Experience | Willingness | |
| Abrasion | : | : |
| Age play | : | : |
| Anal sex | : | : |
| Anal plugs (small) | : | : |
| Anal plugs (large) | : | : |
| Anal plug (public, under clothes) | : | : |
| Animal roles | : | : |
| Arm & leg sleeves (armbinders) | : | : |
| Asphyxiation | : | : |
| Auctioned for charity | : | : |
| Bathroom use control | : | : |
| Beastiality | : | : |
| Beating (soft) | : | : |
| Beating (hard) | : | : |
| Blindfolds | : | : |
| Being serviced (sexual) | : | : |
| Being bitten | : | : |
| Breast/chest bondage | : | : |
| Breath control | : | : |
| Branding | : | : |
| Boot worship | : | : |
| Bondage (light) | : | : |
| Bondage (heavy) | : | : |
| Bondage (multi-day) | : | : |
| Bondage (public, under clothing) | : | : |
| Breast whipping | : | : |
| Brown showers (scat) | : | : |
| Cages (locked inside of) | : | : |
| Caning | : | : |
| Catheterization | : | : |
| Cells/Closets (locked inside of) | : | : |
| Chastity belts | : | : |
| Chaueffering | : | : |
| Choking | : | : |
| Clothespins | : | : |
| Cock worship | : | : |
| Collars (worn in private) | : | : |
| Collars (worn in public) | : | : |
| Competitions (with other Subs) | : | : |
| Corsets (wearing) | : | : |
| Cuffs (leather) | : | : |
| Cuffs (metal) | : | : |
| Cutting | : | : |
| Dilation | : | : |
| Double penetration | : | : |
| Electricity | : | : |
| Enemas | : | : |
| Enforced chastity | : | : |
| Examinations (physical) | : | : |
| Exercise (forced/required) | : | : |
| Exhibitionism (friends) | : | : |
| Exhibitionism (strangers) | : | : |
| Eye contact restrictions | : | : |
| Face slapping | : | : |
| Fantasy abandonment | : | : |
| Fantasy rape | : | : |
| Fantasy gang-rape | : | : |
| Fisting (anal) | : | : |
| Fisting (vaginal) | : | : |
| Following orders | : | : |
| Foot worship | : | : |
| Forced dressing | : | : |
| Forced homosexuality | : | : |
| Forced masturbation | : | : |
| Forced nudity (private) | : | : |
| Forced nudity (around others) | : | : |
| Forced servitude | : | : |
| Full head hoods | : | : |
| Gags (cloth) | : | : |
| Gags (rubber) | : | : |
| Gags (tape) | : | : |
| Genital sex | : | : |
| Given to another Dom (temp) | : | : |
| Given to another Dom (perm) | : | : |
| Golden showers | : | : |
| Hairbrush spankings | : | : |
| Hair pulling | : | : |
| Hand jobs (giving) | : | : |
| Hand jobs (receiving) | : | : |
| Harems (serving w/other subs) | : | : |
| Harnessing (leather) | : | : |
| Harnessing (rope) | : | : |
| Having food chosen for you | : | : |
| Having clothing chosen for you | : | : |
| Head (giving fellatio) | : | : |
| Head (receiving cunninglis) | : | : |
| High heel worship | : | : |
| Homage with tongue (non-sexual) | : | : |
| Hot oils (on genitals) | : | : |
| Hot waxing | : | : |
| Housework (doing) | : | : |
| Human puppy dog | : | : |
| Humiliation (private) | : | : |
| Humiliation (public) | : | : |
| Hypnotism | : | : |
| Ice cubes | : | : |
| Infantalism | : | : |
| Initiation rites | : | : |
| Injections | : | : |
| Intricate (Japanese) rope bondage | : | : |
| Interrogations | : | : |
| Kidnapping | : | : |
| Kneeling | : | : |
| Leather clothing | : | : |
| Leather restraints | : | : |
| Lectures for misbehavior | : | : |
| Licking (non-sexual) | : | : |
| Manacles & Irons | : | : |
| Manacures (giving) | : | : |
| Massage (giving) | : | : |
| Massage (receiving) | : | : |
| Medical scenes | : | : |
| Modeling for erotic photos | : | : |
| Modeling for erotic videos | : | : |
| Mouth bits | : | : |
| Mummification | : | : |
| Nipple clamps | : | : |
| Nipple weights | : | : |
| Oral/anal play (rimming) | : | : |
| Over-the-knee spanking | : | : |
| Orgasm denial | : | : |
| Orgasm control | : | : |
| Outdoor scenes | : | : |
| Outdoor sex | : | : |
| Phone sex (serving Dom) | : | : |
| Phone sex (serving Dom's friends) | : | : |
| Piercing (temporary, play-pierce) | : | : |
| Piercing (permanant) | : | : |
| Prison scenes | : | : |
| Pony slave | : | : |
| Public exposure | : | : |
| Pussy whipping | : | : |
| Riding crops | : | : |
| Riding the "horse" (crotch tort.) | : | : |
| Rituals | : | : |
| Religious scenes | : | : |
| Restrictive rules on behavior | : | : |
| Rubber/latex clothing | : | : |
| Rope body harness | : | : |
| Saran wrapping | : | : |
| Scratching - getting | : | : |
| Scratching - giving | : | : |
| Sensory deprivation | : | : |
| Serving | : | : |
| Serving as art | : | : |
| Serving as ashtray | : | : |
| Serving as furniture | : | : |
| Serving as a maid | : | : |
| Serving as toilet | : | : |
| Serving as waitress/waiter | : | : |
| Serving orally (sexual) | : | : |
| Serving other doms (supervised) | : | : |
| Serving other doms (unsupervised) | : | : |
| Sexual deprivation (short term) | : | : |
| Sexual deprivation (long term) | : | : |
| Shaving (body hair) | : | : |
| Shaving (pubic hair) | : | : |
| Shaving (head hair) | : | : |
| Sleep deprivation | : | : |
| Sleepsacks | : | : |
| Slutty clothing (private) | : | : |
| Slutty clothing (public) | : | : |
| Spanking | : | : |
| Spandex clothing | : | : |
| Speech restrictions (when, what) | : | : |
| Speculums (Anal) | : | : |
| Speculums (vaginal) | : | : |
| Spreader bars | : | : |
| Standing in corner | : | : |
| Stocks | : | : |
| Straight jackets | : | : |
| Strap-on-dildos (sucking on) | : | : |
| Strap-on-dildos (penetrated by) | : | : |
| Strapping (full body beating) | : | : |
| Suspension (upright) | : | : |
| Suspension (inverted) | : | : |
| Suspension (horizontal) | : | : |
| Supplying new partners for Dom | : | : |
| Swallowing semen | : | : |
| Swallowing urine | : | : |
| Swapping (with one couple) | : | : |
| Swinging (multiple couples) | : | : |
| Tattooing | : | : |
| Teasing | : | : |
| Tickling | : | : |
| Triple penetration | : | : |
| Uniforms | : | : |
| Including others | : | : |
| Vaginal dildo | : | : |
| Verbal humiliation | : | : |
| Vibrator on genitals | : | : |
| Voyeurism (watching others) | : | : |
| Voyeurism (your Dom w/others) | : | : |
| Video (watching others) | : | : |
| Video (recordings of you) | : | : |
| Water torture | : | : |
| Wearing symbolic jewelery | : | : |
| Whipping | : | : |
| Wooden paddles | : | : |
| Wrestling | : | : |
Any Other Information You Would Like to Supply Regarding Yourself :
Any Questions For Me?