The Questionnaire

 

Your Delight Lives at the End of My Whip.

I call this ‘Your Delight Lives at the End of My Whip’. This is a mutual favorite of mine and the photographer. Love how she shows me off.

Petition to Offer Submission

 This is to be returned to me in full questions and answer to domina.supreme@yahoo.com in a pdf. Anything less will be discarded. You must include a CLEAR and respectful full body and head shot photo.

__/__/__

Date of birth______________

E-Mail address__________________

Nick or scene name_______________

 

 

Communication is the most important thing in any relationship, but it is even more so in a BDSM relationship. For there to be an exchange of power and control each person must be open and honest. This is with themselves as much as others.

 

Medical History

  1. List all illness/injuries you are being treated for. (Heart, asthma, blood sugar, blood pressure etc.)
  2. List any medications both prescription and over the counter you take regularly, and what they are treating.
  3. All allergies.
  4. Physical/Mental limitations.
  5. Do you exercise regularly?
  6. What type of exercise do you get?
  7. Anything else you feel might be important for me to know.

 

Family History

  1. How would you describe your relationship to each of the members of your family? In three sentences give me a synopsis of your relationship with each of these different people. (We were close, there was friction, we did/didn’t get along etc.)
  2. Are you the oldest/youngest/middle child?
  3. What do you feel are the advantages of each position?
  4. The disadvantages?

 

Educational History

  1. Highest level of schooling you achieved (include degrees attained).
  2. List any areas of special interest/study.
  3. What was your favorite subject?
  4. You’re least favorite?
  5. Creative or artistic outlets
  6. Other skills, talents or pursuits of note

 

Professional History

  1. What is your current occupation?
  2. What types of jobs have you held?
  3. How long were you at each one?
  4. What is/are your career goals both for now and long-term?
  5. Where do you see yourself in 1 year? 5 years?
  6. What did you want to be when you grew up?

 

Relationship History

  1. Tell me about your past to present relationships (i.e. boy/girlfriends and spouses but not limited to sexual). A biography of your significant others.
  2. What were the good and bad points in each relationship?
  3. How long did each last?
  4. Why did they end?
  5. What part did you play in each one as they began and ended?

 

Emotional History

  1. Is there anything that has happened in your life that might affect your ability to serve?
  2. Has there been major emotional upheaval such as the death of someone close, or traumatic events such as abuse both physical and emotional in your life?
  3. Have you ever identified any addictions in your life (chemical, physical, sexual)? If yes, for how long and what has been done to recover from them?

 

Photo by my Sis Mistress Meltz. We were in Chicago visiting each other.

BDSM History

  1. How do you describe yourself? bottom__ submissive__ slave__ other__
  2. How did you find this lifestyle or discover it in yourself?
  3. How long have you been in this lifestyle?
  4. Describe what it is you desire/seek from this type of relationship? What do you “want”?
  5. What do you expect/hope to gain from serving me?
  6. What do you perceive your “needs” are?
  7. What are your current limits, both hard and soft?
  8. List any books you have read on BDSM (both fiction and non-fiction).
  9. Which was your favorite?
  10. Have you ever served another before?  REAL TIME?  Online?  For how long?
  11. Who can act as a reference for you?
  12. What do you offer in service?
  13. Why do you wish to serve me?
  14. Why should I select to accept this petition?
  15. What roadblocks to your service do you know of or feel may need to be addressed?
  16. What feelings do you have about serving alongside others?
  17. Is there anything you would like to tell me in addition?

 

 

This petition was not designed to be all-inclusive. It is designed to get you thinking and to aid Me in making a safe, sound decision for both of us. This petition is not going to cover all of the aspects and issues. There will be much discussion over these questions and others. Your total, open honesty and willingness to COMMUNICATE are the keys to the success or failure of this relationship and all others. Trust is built this way. IF, I should accept this petition I will expect you to follow these keys.

Place a check next to each box which you can relate to the most. If confused, go to the next one, and come back when finished with the rest. Answer each question honestly.

From a June 2011 Photo for Kim Minzter Images in Philadelphia

Where it says “Yes/No” = means whether you’ve experienced that type of activity before. Put “Y” for yes or “N” for no.

Rating scale for checklist:

0 = don’t ever ask me to do this.

1 = I don’t want to do this activity, but wouldn’t object if it was asked of me.

2 = I’m willing to do this activity, but it has no real appeal for me.

3 = I usually like doing this activity, at least on an occasional basis.

4 = I love doing this activity, and would like to experience it on a regular basis.

5 = I love this activity it makes me “hot”, and would like it as often as possible.

Note 1. Some of these may fall under a few categories (example: Blindfolds can be Humiliation & mental bondage)

Note 2. Some of these could be used for health reasons too (example forced exercising)

Note 3. The following DO NOT reflect my personal fetishes. You will have to make it to training to learn those.

CORPORAL PUNISHMENT

Y/N # Activity

__ [ ] Belts

__ [ ] Bruises

__ [ ] Cane

__ [ ] Crop

__ [ ] Paddle

__ [ ] Spanking

__ [ ] Whip

ROLE PLAY

Y/N # Activity

__ [ ] Arrested

__ [ ] Burglar Attack

__ [ ] Interrogation Scene

__ [ ] Kidnap Scene

__ [ ] Maid

__ [ ] Pet Roles

__ [ ] Secretary

__ [ ] Torture Victim

HUMILIATION

Y/N # Activity

__ [ ] Act as objects (furniture, etc.)

__ [ ] Bathroom use control

__ [ ] Bathroom use in front of others

__ [ ] Blindfolds

__ [ ] Boot worship

__ [ ] Chauffeur

__ [ ] Crawl on 4′s

__ [ ] Cross Dressing

__ [ ] Curse words (Whore, Slut, etc.)

__ [ ] Curtsy in public

__ [ ] Dom chooses food

__ [ ] Dom chooses cloths

__ [ ] Enema

__ [ ] Eye contact restrictions

__ [ ] Foot worship

__ [ ] Forced Cross dressing

__ [ ] Forced dressing

__ [ ] Forced exercising

__ [ ] Forced nudity

__ [ ] Forced slave auction

__ [ ] Forced to be a slave

__ [ ] Forced to wear a leash

__ [ ] Forced to wear see thru clothes

__ [ ] Golden shower

__ [ ] Harem–serving w/other(s)

__ [ ] Hood

__ [ ] Kneeling

__ [ ] Maid services

__ [ ] Scolding

__ [ ] Spitting in face

__ [ ] Serve as ashtray

__ [ ] Serve as toilet

__ [ ] Serve as waitress

__ [ ] Serve others (supervised)

__ [ ] Shave head

__ [ ] Shave body hair

__ [ ] Shave pubic hair

__ [ ] Slap face

__ [ ] Speech restriction

__ [ ] Stand in corner

__ [ ] Swallow urine

__ [ ] Take Pictures

__ [ ] Take Video

__ [ ] Verbal Abuse

__ [ ] Wear Collar everywhere

__ [ ] Write on Body (slut, sissy, worthless, etc.)

BONDAGE

Y/N # Activity

__ [ ] Arm Sleeves

__ [ ] Blindfolds

__ [ ] Breasts

__ [ ] Gag

__ [ ] Cage

__ [ ] Chain

__ [ ] Chastity Belts

__ [ ] Genital

__ [ ] Harness

__ [ ] Hoods

__ [ ] Immobilization (short time)

__ [ ] Immobilization (long time)

__ [ ] Inside a closet

__ [ ] Inside a coffin

__ [ ] Katherine wheel

__ [ ] Leather cuffs

__ [ ] Leather restraints

__ [ ] Leg Sleeves

__ [ ] Mask

__ [ ] Mind

__ [ ] Mortuary bag

__ [ ] Mouth bits

__ [ ] Nipple Clamps

__ [ ] Rack

__ [ ] Rope

__ [ ] Saran wrapping

__ [ ] Scarves

__ [ ] Shackles

__ [ ] Sleeping bag

__ [ ] Sling

__ [ ] Spread bar

__ [ ] Steel cuffs

__ [ ] Steel restraints

__ [ ] Stock

__ [ ] Straight jacket

__ [ ] Suspension (regular)

__ [ ] Suspension (up-side down)

__ [ ] Suspension (horizontal)

__ [ ] Tied to a cross

EDGE/MIND PLAY

Y/N # Activity

__ [ ] Abrasion

__ [ ] Branding

__ [ ] Choking

__ [ ] Cloth Pins

__ [ ] Cutting

__ [ ] Electric (violet wand)

__ [ ] Electric (muscle stimulant unit)

__ [ ] Flesh Hooks

__ [ ] Genital (weights)

__ [ ] Genital (cloth pins)

__ [ ] Genital (pins/needles)

__ [ ] Genital (rope)

__ [ ] Genital (vice)

__ [ ] Genital whipping

__ [ ] Hair Pulling

__ [ ] Hot wax

__ [ ] Ice

__ [ ] Fire and Ice (same time)

__ [ ] Knife play

__ [ ] Needles

__ [ ] Piercing

__ [ ] Pinching

__ [ ] Sleep deprivation

__ [ ] TENS units

__ [ ] Tickling

__ [ ] Torture rack

__ [ ] Water torture

__ [ ] scarifications

FETISH WEAR

Y/N # Activity

__ [ ] Corsets

__ [ ] French maid

__ [ ] High Heels

__ [ ] Leather

__ [ ] Lingerie

__ [ ] PVC

__ [ ] Rubber

__ [ ] Slutty

__ [ ] Spandex

__ [ ] Uniforms

__ [ ] Victorian

SEXUAL D/S

Y/N # Activity

__ [ ] Anal

__ [ ] Anal beads

__ [ ] Anal plugs (small)

__ [ ] Anal plugs (large)

__ [ ] Anal fisting

__ [ ] Anal (vibrator/dildo)

__ [ ] Ben-wa balls

__ [ ] Bi-sexuality

__ [ ] Chastity Belt

__ [ ] Cock Worship

__ [ ] Forced bi-sexuality

__ [ ] Hand jobs (giving)

__ [ ] Oral sex (giving)

__ [ ] Orgasm Control

__ [ ] Orgasm Denial

__ [ ] Phone sex (voluntary)

__ [ ] Phone sex (forced to have it with others)

__ [ ] Sexual denial (short-term)

__ [ ] Sexual denial (long-term)

__ [ ] Sexual Double Penetration

__ [ ] Swallow semen

__ [ ] Voyeurism (watching master play w/others)

__ [ ] Voyeurism (watching other play)

Photo taken by Masterscout639

WRITTEN INFORMATION:

*Write down any other role play activities not mentioned above, which you may be interested to try:

 

*At this stage, what do you feel are your absolute limits?

 

*Do you have any medical conditions and emotional concerns that I should know about? (If yes explain below):

 

*Why and when did you get into the scene?

 

*What do you seek from your Dominant?

 

*What do you offer as a submissive (emotionally and spiritually?)



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One Comment      Leave a comment.

  1. on June 30, 2014 at 1:07 AMLock3dfemme Said:

    Taking it all in.

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