Session Request Form
One step closer to reality
Full Name
*
First Name
Last Name
DOB (mm/dd/yyyy)
*
Phone Number
*
Please enter a valid phone number.
Email Validator
*
Take Valid ID Photo
*
Have you sessioned with a pro dom before? List 2 references, if not, put n/a
*
Include emails and websites/media
Preferred method of contact?
Level of Experience
*
Exploring/beginner
A few sessions
Semi-regular
Seasoned
Type of Session
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Please Select
half hour
power hour
2 hr
6 hr
FMTY
Double Domme
Add Ons?
Specialty
Panties
If specialty, which?
Introduce yourself to Me. Your response will help me determine if we have similar interests.
*
Existing health issues, allergies, current medications?
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Blood thinners, rock fruit allergy, etc
Hard limits
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How do you want to feel during and/or after the session?
What is your preferred form of aftercare? Do you need it for this scene?
Why do you want to session with me?
*
How did you hear about me?
*
Do I have your permission to take pictures and/or videos of our session for my platforms? Face and distinguishable features can/will be covered upon request.
*
Yes
No
How will you be submitting your deposit?
*
Please Select
Cash App
Venmo
Visa Gift card
These are the only forms of payment I accept for deposits
Agreement: By submitting this form I am agreeing to the following: *I am requesting at my own risk to participate in a BDSM session.*I am a consenting adult over the age of 18.*I am solely responsible to advocate and speak up about my boundaries and well being with no prejudice against me. *I have read and familiarized myself with Mistress Hellga’s policies and boundaries and will not negotiate them or Her tributes.*I have provided and answered the required fields truthfully and to the best of my ability.*If accepted, I will promptly provide the necessary deposit and understand agree to an approximate 10-15 minute video call with Mistress Hellga that is MANDATORY before discussions of securing session date and time will occur. *I understand that Domination does not involve sex or any other illegal activities and requests.
Agree
Disagree
Submit
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