Name:
Email Address:
slave name
Your Age
Home Town/City
Telephone (Optional)
Is it OK to leave a discreet voice mail on this number?
Yes
No
Best time(s) to return a call?
How did you hear about me?
Search Engine i.e. Google
Yahoo 360 Profile
Multiply
MySpace
Pandemos
Collarme
Other
(If you answered "other" to the above, please specify)
Check all that apply to Health Status
Heart Conditions
Spinal Problems
Joint Problems
Injuries
High or Low Blood Pressure
Diabetes
HIV Positive
Sexual Orientation
Heterosexual
Homosexual
Bisexual
Bi-Curious
Do you suffer from any phobias
and if so how does this affect you?
Do you have any health issues
that the Mistress should know about?
Can you be marked?
Yes, permanently
Yes, temporarily (fading in 2 to 3 days)
No, not at all
Which of the following most describes you?
Masochistic
Submissive
Fetishist
Just Exploring
Regarding S & M
No pain for me
i will take pain to please You, Mistress
i enjoy pain and can take a moderate amount
Just Exploring
i am a total pain slut...pull out all stops!
Your level of experience of BDSM play is?
Total Novice
Some play with partners
Sessions with Professional Dommes
Other
If you answered "other" to the above question, please elaborate
My choice of outfit for a session is ultimately My choice, but I can entertain requests. Indicate your preferences below
Leather
PVC
Rubber
Uniform/ Fantasy Wear
Boots
Stilettos
Stockings
Other, (please specify below)
What are some other things you would like to see Me wearing during O/our session?
Which of the following activities do you enjoy most as a submissive or wish to explore further?
Anal (Dildos/Strap-on)
Ass Worship
Blindfolds
Bondage
Caning
Caging
Chains
"Champagne" Cocktails
Candle Wax
Clips & Clamps
Cling Film
Cock & Ball Torture
Collar & Lead
Crops & Whips
Cross Dressing & Gender Play
Cuckold Fantasy
Depilation (Shaving)
Discipline
Domestic Servitude
Electrics
Flogging
Foot Worship
Forced Feminisation
Forced Bi-sexuality
Gags
Glove Worship
Golden Showers
Hand Worship
High Heel Torture
Hair Pulling
Humiliation (Physical/Verbal)
Humiliation (Public)
Imprisonment (Capture Fantasy)
Kicking
Leg Worship
Masks & Hoods
Mummification
Nipple Torture
Oral Strap on Training
Paddling
Pony Training
Role Play
Slapping
Spanking
Shoe Worship
Sissification
Tickling
Trampling
If you could have your perfect scenario,
what would it be?
Do you have any other information I should be
aware of or anything you would like to ask me?
Please
indicate when you would like a session with Me.
List all the days of the week and times of day
you are generally able to serve
Propose specific date(s) that you will be traveling here
Other travel and session options for you to consider
i would compensate You to travel to me Mistress.
i would provide transportation & lodging for You.
i can session if You happen to be in my area.
Can i schedule a webcam session Mistress?
Can i schedule a phone session Mistress?
Please indicate that you understand the following statement; I understand that You, Mistress Divinyl, are a Professional Dominatrix, and as such, do command a tribute. I have read and understand the specifics outlined in this site and am able and honored to fulfill these requirements.
Yes
No