EmailMe Form - Questionnaire

Questionnaire

If you're interested in booking an appointment then please fill out this form in full.
All information is confidential and deleted once reviewed.

After you fill out this form you are responsible for calling to reserve your appointment. Filling out this form does NOT hold your appointment slot or guarantee an appointment. Please call after you have filled out this questionnaire between our regular phone hours.

Calls are accepted Monday-Saturday from Noon-10pm. 202-709-5634.

On your Knees!
Mistress Tiffany & Associates

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Name
Your first name is fine and last Initial if you do not wish to use your full name. *
First Last
Your first name is fine and last Initial if you do not wish to use your full name.
Email *

Confirm
Phone
### - ### - ####
This is not required.
Age *
Session Information
Please fill out this section as honestly as you can so we can understand what you're looking for.
Who do you wish to have an appointment with? *
Select from the drop down menu who you would like to book your session with.
Date Time of desired appointment (Option 1) *
MM / DD / YYYY HH : MM AM/PM
Date Time of desired appointment (Option 2) *
MM / DD / YYYY HH : MM AM/PM
Appointment duration: *
A retainer will be required in order for you to reserve your appointment. Retainers/deposits vary depending on session type and duration.
Desired Appointment location: *
Incall at Mistress Tiffany's fully equipped dungeon
Outcall at your house/apartment (2 hour minimum)
Outcall at your upscale hotel (2 hour minimum)
FMTY/TMTY. I would like Mistress Tiffany to travel to me
Check all that interest you:

Make sure you read & know your desired Dommes interests & boundaries as each associate has different experience and interests. *
Bondage-Being immobilized
Humiliation/Degradation
Toy-Play/straps
Chastity
O -control and denial
Face slapping
Spanking
Floggers- soft to medium impact
Single tails - whips - stingy whips
Face sitting/Smothering
Crossdressing/Sissy Play
Foot fetishes
Hosiery/stocking fetishes
Tickle torture
Mummification or Latex Vac bed
Sensory deprivation/Sensory Play
Physical Domination
Trampling
Psychological Domination
Corporal Punishment
G. Showers
Enemas
Nail Fetishes
Smoking fetishes
Heel/Shoe/Boot fetishes
Hoods or blindfolds
Gags
CBT/CBB
Objectification
Spitting
Medical Play (caths/sounds/needles)
Electro Play (tens/violet wand)
Full makeover & Play (3 hours or longer)
Breath play (done safely)
Choking (done safely)
Sploshing/WAM
ABDL (must provide your own supplies)
Counseling/coaching
Other
Everything I have listed here I am experienced in and do safely.
Please list any other interest you may have:
I also suggest listing your top 3 favorite activities.
What persona best suits your session? *
Teasing/Taunting
Strict/High Protocol
Aggressive
Quiet and emotionless/Silent session
Playful
Laidback
Friendly
Try to only select 1 that you feel sets the scene the best. You may select up to 2.
How do you prefer to send your retainer/deposit? *
Venmo
Cash app
Other
A retainer/deposit will be required when you call to book for your appointment. Preferred options for receiving a retainer are via Venmo/Cash app if you select “other“ those options can be discussed over the phone or email before you book your appointment keep in mind other options are up to the decision of Mistress Tiffany and could delay booking your session 2-3 days.
Gift cards are NOT an option for sending a retainer.
Please list any specific clothing fetishes that are important to your session (nude is NOT an option).
This is NOT intended for clothing request. This is for those who have specific fetishes that go with their session.
Any other comments, questions or statements you may want to add?
What area would you like to see Me in? *
N. VA area (My main location)
FMTY/TMTY (I would like Mistress Tiffany to travel to me
Other. (indicate in the comments section above)
My home based area where I am located is the DC/Northern Virginia area. I have added locations where I have upcoming tours. If you were wanting to see me while touring, please select the appropriate location.
Keep in mind when Touring I require a two hour minimum and there is an additional (Touring rates may be a little higher then My base DC/NOVA rates). I do require a 50% deposit when touring too locations outside of the DC/Northern Virginia area. Thank you for understanding.
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Session Information

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