Session Vetting Form
Thank you for expressing interest in receiving services from TheeBlaqueDahlia! Please take a moment to fill out this form in it’s entirety. NOTE: Your submission does not confirm any session. After reviewing your submission, you will receive correspondence via email regarding your screening status.
Scene Name
*
Full Name (for verification purposes only)
*
First Name
Last Name
Pronouns
*
He/Him
She/Her
They/Them
He/They
She/They
Ze/Zir
Xe/Xem
Other
Age
*
Must be at least 21
What is your gender identity?
Ex: cisgendered woman, non-binary masc, genderqueer
How would you classify your sexuality?
*
Ex: Heterosexual, queer, lesbian, bisexual
How do you identify within the kink community?
*
Ex: sub, pet, little, kink-curious
Email
*
example@example.com
Social Media Name (Instagram, Twitter, Fetlife)
*
Ex: @theeblaquedahlia-Instagram
References
Any professionals you have received services from, former play partner(s), etc.
Photo ID
*
Browse Files
Please upload a picture of your Driver’s License/ID for verification purposes.
Cancel
of
Location
*
Are you seeking in person or virtual services?
*
In person- I reside in Memphis
In person- I reside in Chicago
Virtual
I do not reside in Memphis or Chicago but am interested in requesting travel policy
Which are you interested in?
*
Booking a session
Becoming a short-term sub
Becoming a long-term sub
Other
What type of session are you seeking?
*
Soft & Hard Limits
Please be as thorough as possible when listing these.
Do you have specific injuries, traumas, or accessibility needs I should be aware of?
What intrigues you most about sessions with TheeBlaqueDahlia?
*
Would you be comfortable with me filming/taking pictures during our session? (I will ensure your identity is protected)
Yes
No
Possibly
What does the acronym PRICK mean in regards to consent? Describe what this means in your own words.
*
How did you hear about TheeBlaqueDahlia?
Please Select
Facebook
Instagram
Fetlife
Word of Mouth
Referral
Before you hit submit!
If you are a cishet (straight) male or non-black or non-POC person, you are REQUIRED to send $50 tribute to CashApp$yourhighnessDahlia. Please include your name in the notes of the payment. Failure to comply will result in your form being trashed. You’ve been warned!
Submit
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