Submissive Intake &
Consultation Questionnaire

Before we meet, I want to understand a little about who you are, what draws you to submission, and what you hope to explore.

You do not need to have everything figured out. You may be here precisely because you don't.

Answer honestly rather than trying to give the answers you think a Dominatrix wants to hear. This questionnaire helps me determine whether we are a good fit and gives us a starting point for our consultation.

Applicants must be 21 years of age or older.
Step 1 of 6
About You

About You

Start with a little basic information so I know who I am speaking with and where you are beginning.

You must be 21 or older to continue.
What is your current level of experience? *

What Brings You to Me?

Tell me what kind of experience you are looking for and what you hope to get from our work together.

What type of experience are you currently looking for? *

Your Relationship to Submission

Submission can mean very different things to different people. Tell me a little about what draws you to it and what you imagine experiencing within a submissive dynamic.

What about submission is compelling to you? Choose anything that resonates.

How Your Mind Works

Different forms of attention, correction, challenge, and approval affect people in very different ways. This gives me a better sense of what may get into your head and what kinds of dynamics are most psychologically compelling to you.

Which would affect you most strongly? Choose anything that resonates.

Kinks & Interests

For each interest below, choose the answer that best represents where you are right now. Expressing interest here does not constitute consent to any specific activity.

Bondage / restraint / rope
Impact play / spanking
Flogging / paddles / crops
Sensation play
Sensory deprivation / blindfolds
Pain / endurance
Kneeling / positions / posture
Protocols and rules
Service
Slave-style training
Collars / ownership symbolism
Chastity / orgasm control
Tease & denial
Verbal humiliation
Objectification
Begging / pleading
Clothing or gender-expression play
Foot / boot fetish
Role play
Pet / animal-style play
Medical-style role play
Interrogation / authority scenarios
Psychological dominance / mind games
CBT / ball busting
Electro-play
What are your three strongest interests or fantasies right now? These can be activities from the list above or something more specific.

Limits, Safety & One Last Thing

These final questions help me understand any limits, safety considerations, or important information I should know before we meet.

Do you have any physical conditions, injuries, medications, allergies, mobility limitations, circulation issues, numbness or nerve concerns, breathing concerns, or other medical considerations that could affect BDSM activities?
Have you ever experienced panic, dissociation, freezing, or an unexpected emotional reaction during kink or another intense experience?

One Last Thing...

What kind of Dominant energy affects you most? Choose anything that resonates.
Before submitting, please confirm: