Name
DATE OF BIRTH MM/DD/YYYY
Email ADDRESS
CONFIRM YOUR EMAIL ADDRESS
EXPERIENCE
  • THIS IS MY FIRST BDSM EXPERIENCE
  • THIS IS MY FIRST IN-PERSON EXPERIENCE BUT I'VE PLAYED ONLINE BEFORE
  • THIS IS MY FIRST PROFESSIONAL BDSM EXPERIENCE BUT I'VE PLAYED WITH PERSONAL PARTNERS BEFORE
  • I HAVE SEEN 1-5 PROFESSIONAL DOMINATRICES
  • I HAVE SEEN 5-11 PROFESSIONAL DOMINATRICES
  • I HAVE SEEN 11-20 PROFESSIONAL DOMINATRICES
  • I HAVE SEEN 20+ PROFESSIONAL DOMINATRICES
DESIRED DURATION OF PLAY
  • 1 HOUR
  • 1.5 HOURS
  • 2 HOURS
  • 2.5 HOURS
  • 3 HOURS
  • 3.5 HOURS
  • 4 HOURS
  • 4.5 HOURS
  • 5 HOURS
  • 5.5 HOURS
  • 6 HOURS
  • 6.5 HOURS
  • 7 HOURS
  • 7.5 HOURS
  • 8 HOURS
  • 12 HOURS
  • 24 HOURS
  • 36 HOURS
  • 48 HOURS
  • 60 HOURS
  • 72 HOURS
DESIRED CITY
WHAT ARE YOUR DATES AND RANGE OF AVAILABILITY?
HEALTH & LIMITS: CHECK ALL THAT APPLY
Pain?
  • The more pain the better (11/10)
  • I'll take as much pain (?/10) as it pleases Domina Carmen
  • I CAN take a moderate amount of pain (6/10)
  • I CAN take a light amount of pain (2/10)
  • I prefer a pain-free humiliation experience
  • I prefer a pain-free sensory experience
  • I prefer a pain-free training experience
MARKS?
  • The more the better!
  • Marks that last a week or so are fine
  • Marks that last a few days are fine
  • Marks that last a few hours are fine
  • I cannot have marks whatsoever
WHAT INTERESTS WOULD YOU LIKE TO EXPLORE: CHECK ALL THAT APPLY
HOW WOULD YOU LIKE TO FEEL DURING OUR SESSION?
Use THE SPACE BELOW TO FURTHER ELABORATE ON YOUR INTERESTS & HOW YOU WOULD LIKE TO FEEL DURING OUR PLAY
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THINKING BACK TO PAST SESSIONS, EITHER WITH MYSELF OR OTHER PROVIDERS, WHAT EXPERIENCES WERE LESS FUFILLING? WHAT EXPERIENCES OR MOMENTS POSITIVELY RESONATED WITH YOU AND WHY?
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CHECK ALL THAT ARE TRUE FOR YOU