Client Intake Questionnaire

1
Preferred Name* This field is required.
First Name
2
Email* This field is required.Preferred private email. To protect your anonymity, it is suggested to create an email that does not include your name.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
3
Which site did you find me initially?* This field is required.When making marketing decisions, I analyze the sources my clients use in finding me. Thank you for sharing this information!
Please Select
Please Select
CarolinaMistress.com
CarolinaDominatrix.com
DommeoftheCarolinas.com
Fetlife.com
Tryst.link
Slixa.com
PurgatoryPlaymate.com
website
4
Interest* This field is required.
Please Select
Please Select
Submissive
Mentorship
Couple's Session
5
Fetlife NameIf you're a member of Fetlife.com, please provide name. You can follow me there at "hookedforlife"!
6
AgeGenerally, so I know who to look for when vetting in-person.
7
Kinks, Curiosities* This field is required.Please be descriptive. It may be worth knowing that I do not participate in face-sitting/smothering with new clients, golden showers/piss play, or scat. Sexual contact is never an option and asking anytime during a session will invoke a swift and permanent dismissal.
Huge
Large
Normal
Small
Ok
Ok
8
Hard Limits / LimitationsActivities that you absolutely want no part of, or health/physical limitations I should be aware of i.e. pacemaker, on blood-thinners, diabetes, bad knees, etc.
Huge
Large
Normal
Small
Ok
Ok
9
City, State* This field is required.for demographic analysis only
10
Typical Availability
11
Beck & Call?If you are local to Charlotte, NC, would you like to be added to this list if I have last-minute cancellations to fill?
YESNO
12
Slave ServicesAre you willing to provide your services doing any of the following?
Basic Yardwork
Domestic Housework
Massage
Handyman
Errand boy
Chauffeur
Other
13
Are photos/videos allowed?Sharing can mean via my social media platforms, i.e. Fetlife.com, via marketing materials for my websites, or for sale i.e. OnlyFans, clips4sale, etc.
Only photos, no face, no sharing
Photos and videos, no face, no sharing
Photos/videos, no face, share
Photos/videos, no face, for sale
Absolutely NO PHOTOS/VIDEOS
Should be Empty: