EmailMeForm
Session Intent Form.
For Madame Rax in Chicago, IL.
Name
First
Last
Age:
Phone
###
-
###
-
####
Gender:
Please select
Male
Female
Transsexual MtF
Transsexual FtM
Two-Spirit
Third Gender
Intersex
Other
BDSM Experience:
None/Little
1-3 Dommes
4-9 Dommes
10+ Dommes
Interests:
Beatings
Begging
Mummification
Flogging
Caning
Spanking (Barehanded)
Spanking (Hairbrush)
Spanking (Other Implement)
E-Stim (TENS Unit)
Cross-Dressing/Sissification
Circus Freak Transformation
Nipple Clamps
CBT
Breath Play
Service (Tea, Coffee, Snacks)
Bondage
Bad Girlfriend/Shopping Spree
Public Play
Pony Play
Puppy Play
Financial Domination
Edgeplay
AB/DL
Tolerance:
Pain
Low Tolerance
Medium Tolerance
High Tolerance
Dislike
Hard Limit
No Opinion
Curious
Bondage
Low Tolerance
Medium Tolerance
High Tolerance
Dislike
Hard Limit
No Opinion
Curious
Breath Play
Low Tolerance
Medium Tolerance
High Tolerance
Dislike
Hard Limit
No Opinion
Curious
Trampling
Low Tolerance
Medium Tolerance
High Tolerance
Dislike
Hard Limit
No Opinion
Curious
Humiliation
Low Tolerance
Medium Tolerance
High Tolerance
Dislike
Hard Limit
No Opinion
Curious
Feminization
Low Tolerance
Medium Tolerance
High Tolerance
Dislike
Hard Limit
No Opinion
Curious
Describe an ideal session:
600 Character Limit; Email if more is necessary.
Best and Worst BDSM Experiences:
Other Information:
Use this space to describe what makes you unique or valuable, so I may customize your session to be as optimal as possible.
Physical Health Issues:
Do you have mental health issues:
Yes
No
Other (explain)
Mental Health Issues:
Explain if 'Yes' or 'Other' were checked.
Powered by
EMF
Contact Form
Report Abuse
