Prospective Submissive Intake Form

Prospective Submissive Intake Form

Share your background, boundaries, and availability so Mistress Grace can assess compatibility and set respectful expectations.
Personal Information
Full Name

First NameMiddle NameLast Name
Preferred Name
Age
Date of Birth

MonthDayYear
Date
City / State
Occupation
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
BDSM Experience
Length of time involved in BDSM or power exchange
Previously served another Dominant?
Description of prior service or power exchange experience
How do you identify?
Interests
What interests you about serving Mistress Grace?
What skills, talents, or services do you bring?
What does submission mean to you?
Limits & Medical Information
Hard Limits
Soft Limits
Medical Conditions or Injuries to Disclose
Allergies
Service Preferences
Service format preference
Online service preferences

Other
Hours available per week
Served online before?
If yes, describe your online service experience
In-person non-sexual service interests

Other
Maximum travel distance (miles)
Availability
Days Available
Preferred Start Time

Hour Minutes

AM/PM Option
Communication
Preferred Method of Communication

Other
Typical Response Speed
Have you ever abruptly stopped responding to a Dominant?
If yes, please briefly explain
Content Creation
Willing to participate in photographs?
Willing to participate in video recordings?
Willing to wear a mask or other covering to conceal identity?
Verification
Are you willing to verify your identity?
Are you willing to complete a background check if requested?
Expectations
What do you hope to gain from serving Mistress Grace?
Describe your ideal service dynamic.
How do you typically respond to correction or constructive criticism?
Important Boundaries & Acknowledgement
I understand that submission is a privilege, not an entitlement
I understand that Mistress Grace may refuse or terminate any dynamic at any time
I understand that honesty, discretion, respect, and professionalism are expected at all times
I understand that Mistress Grace does not engage in sexual intercourse or any form of penetration with submissives or clients
I understand that requesting, expecting, attempting to negotiate, or attempting to obtain sexual access to Mistress Grace will result in immediate rejection or termination of the dynamic
I agree that there will be no penetration of Mistress Grace under any circumstances, and I will respect this boundary without exception
Applicant Certification
I certify that I am 18 years of age or older
I affirm that the information provided is true, complete, and accurate to the best of my knowledge
I acknowledge that submitting this application does not guarantee acceptance and that any future interaction is subject to Mistress Grace’s sole discretion
Applicant Signature
Printed Name

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Should be Empty:

Prospective Submissive Intake Form

Personal Information

BDSM Experience

Interests

Limits & Medical Information

Service Preferences

Availability

Communication

Content Creation

Verification

Expectations

Important Boundaries & Acknowledgement

Applicant Certification