Session Intent Form.
For Review by Madame Rax in Chicago.
  • Personal Information

  • Only if different from name provided above.
  • Everyone has pronouns, specify the ones you prefer.
  • (xxx) xxx-xxxx. If Whatsapp is used, change country code.
  • This must be an email that is reachable by Madame.
  • BDSM Experience and Interests

  • Pain
    Bondage
    Breath Play
    Trampling
    Humiliation
    Feminization
  • 600 Character Limit; Email if more is necessary.
  • Use this space to describe anything you want Madame to know.
  • Quirks and Liabilities

  • Write "N/A" if you truly have no physical health issues.
  • Explain if 'Yes' or 'Other' were checked.
  • Neurodivergent umbrella is fairly large; please choose wisely.
  • Appearance

  • Recent pictures are best.
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