Appointment Request Form

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TERMS AND CONDITIONS* This field is required.
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Name* This field is required.
First Name
Last Name
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Contact Number* This field is required.
Please enter a valid phone number.
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Email Address* This field is required.
example@example.com
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What are your pronouns?* This field is required.He/him, She/her, They/them, other
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Session Type* This field is required.What sort of session are you hoping to experience with Me
Please Select
Please Select
Classic Domination
Foot Fetish Play
Japanese Rope bondage/Shibari
Ritualistic Kink
Other
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Tell me more about yourself and your prior experiences with kink/BDSM:* This field is required.
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Why are you looking to session with a Dominatrix at this time?* This field is required.
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What is it about Me in particular that has inspired you to contact Me?
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Ok
Ok
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How do you plan on making yourself useful to Me?
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Ok
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How do you best identify with your role in BDSM? * This field is required.
Please Select
Please Select
Submissive
Slave
Fetishist
Masochist
Pet
Boy/Girl
Thing
Other
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What specific feelings do you hope to experience during Our time together?
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Ok
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What activities are you hoping to explore with Me in our session?
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Ok
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What session activities have you enjoyed, and not enjoyed, in the past?
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Ok
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What sort of attitude in a Dominant are you most drawn to?
Cold, distant, disapproving
Cruel, wicked, mischevious
Motherly, nurturing, sweet
Strict, unrelenting, aggressive
Other
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Desired Experience Length
Fool's Game (1hr)
Lover's Tryst (2hrs)
Sacred Retreat (4hrs)
Dinner and Domination (4hrs)
Goth Girlfriend Experience (4hrs)
Full Evening Date (Dinner to Midnight)
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I require an intake phone call prior to session. It is a requirement of all new clients to better get to know one another. * This field is required.I require a $60 energy-exchange for this call. Select 'Yes' if you consent to this step in my vetting process.
YESNO
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Conditions, Limits, and BoundariesParticipating in sessions involving BDSM activities can put stress on the body. Please disclose any and all health Issues/medical conditions/Mobility Limitations so that I may determine what activities should be modified or avoided. The more thorough you are on this, the happier we will both be in the session! Hard limits include specific phrases, activities, places I should not touch, etc. * It is your responsibility to disclose any of the above or anything else that may not be listed. *
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Provide the website/social media and contact email of two providers you have seen in the last 6 to 12 months. If you are new, write 'new' or elaborate.* This field is required.
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Lastly, how did you find Me?* This field is required.
Tryst
Fetlife
Instagram
In-person event
Twitter/X
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