Please be assured that any information you disclose will be used solely for the purpose of dealing with you as a client.  All information will be kept strictly confidential, as I realize that discretion is of the utmost importance.  Feel free, however to omit your last name, or even create a new name for yourself.  

DO NOT FILL THIS OUT UNLESS YOU ALREADY HAVE AN APPOINTMENT!!!  CONTACT INFORMATION IS A MUST!!!!

DO NOT BORE ME!!!!

"Name or Slave name"
How did you hear of me?	Website Eros Guide Houston Press DDI Max Fisch Referral
ABOUT YOURSELF:
What is your age?	21-30 31-40 41-50 51-60 61-beyond
How can you be reached?  (on the day on your appointment, you MUST confirm with the mistress, if confirmation is not made you won't have an appointment)
I can be paged:
Here is my cellular #:
Here is my home #:
Your e-mail address:
What level of player do you consider yourself?	just Curious Novice some experience very experienced Lifestyle
How often do you play?	first time Very Seldom Monthly Weekly Daily
How long have you been playing?
What other Mistresses or establishments have you visited?
List any BDSM organizations with which you are or have been associated:
Briefly describe your experience in being submissive.  Feel free to include other sessions you have had, relationships you have been in, scenes you have done at play parties, etc.
Do you have any injuries or medical conditions of which I should be aware? (i.e., bad knees, asthma, claustrophobia. etc.)
Briefly explain why you are worthy of My domination: (This can not be left unanswered!)
ABOUT YOUR SESSION:
Do you want to experience pain in your session?	Yes No
Indicated which of the following character types you would like a Mistress to project.
Goddess Police Woman Seductress Biker Bitch Mommy Employer or Boss Doctor or Nurse Auntie Head Mistress Teacher School Girl   Military Officer Leather Lady Other:        Indicate which of the following roles you identify with:       Slave Slut Patient Student Animal Masochist Prisoner Child/Baby Girl         Other:
Do you want to be restrained (in bondage) during your session?	Yes No
Can you be marked in any way during your session?
I can not be marked in any way Temp Redness is okay. Some light bruising or welts is okay I want to keep the marks awhile my body belongs to you, draw blood if it pleases you
Comments:
Describe your fantasy session: