Form
Stacy Quartz's
Session Application
Name
First Name
Last Name
What is your legal age
Email
example@example.com
Where are you located?
Desired duration of session?
1 hr
1.5 hr
2 hr
3 hr
What type of Session are you interested in?
IN Person Pro Domme
Online Virtual Pro Domme
Have you ever been to a professional dominatrix before? If Yes, be prepared to supply a reference if requested
Yes
No
If answered 'Yes" above who was the professional?
Gender Identity
Female
Male
Non-Binary
Transgender - MTF
Trangender - FTM
Preferred Pro-Nouns during scene
She / Her
He / Him
They / Them
Preferred Pro-Nouns outside of scene
She / Her
He / Him
They / Them
What is your experience in the lifestyle and with what activites of kink or BDSM?
What feelings are you trying to chase or feel?
List your kinks and fetishes
Are there any kink related traumas I should be aware of?
What do you hope to accomplish with Stacy Quartz and our session?
Do you have any long term fetish/bdsm goals?
What do YOU enjoy wearing during a scene?
Slave Attire
Rubber or Latex
Medical Gown
Cross Dress
Sissy Attire
Naked
None of the Above
I enjoy the following activities
Humilation
Teasing
Exhibitionism
Medical Patient
Verbal Degradtion
Forced Degradation
Golden Showers
Forced Swallowing of MY OWN CUM
Anal (Fisting)
Anal (Dildo)
Anal (Pegging)
Sensation Play (pain / pleasure mixed)
Predicament Play
ABDL
Sissification
Corporal Punishment (Impact Play)
Fantasy Roleplay
Urethral Sounding or Catheters
Needles
Tickling
Electro Play
Hot Wax
Bondage
Chastity
Nipple Clamps
Breathplay
CBT
What type of Domme style are looking for? It is okay if you are unsure
Do you have any medical conditions that I should know about, that may affect you during a session?
Yes
No
If 'Yes' to the above, then outline any concerns that I should be made aware of?
For the Bottom/ S - What form do you most identify with?
Bottom
Slave
Submission
Fetishist
Pet
Sissy
Slut
Masochist
AB/DL
Unsure
Are you claustrophobic?
Yes
No
If 'Yes' to the above, then outline any concerns that I should be made aware of
In general can you leave our session with marks?
Yes
No
Do you give your consent to be marked during our session? Also any specific areas to avoid?
Are you allergic to latex?
Yes
No
Do you have any allergies I need to be aware?
What specific toys/props do you request Stacy Quartz to consider using in your next session?
Are there any specific restraints you hope you can use in your next session with Stacy Quartz?
What are your soft limits ? (A soft limit is something that you are currently not interested in but could be open to exploring later in another session as we get to know each other)
What are your hard limits (A hard limit is something that must not be done ever. Boundries that must be respected.)
I declare that the information that I have provided to Stacy Quartz is 100% factual. I understand that if for any reason Stacy Quartz finds any untruths in the information above that it can be used as a valid reason for not moving forward to the next vetting stage and session booking. I understand that despite filling out the vetting form above it does not mean that a session booking is guaranteed. I consent to the conditions outlined in this statement and that by checking this box it is to be treated as the equivalent of a digital signature.
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