Submissive Questionnaire

Name (Your scene name – we will get to real names later on):



Email Address:




Marital Status

__ Single

__ Attached/Taken

__ Married

Does your partner know you are looking for a Dominant?

Do you:



__Use Recreational Drugs

If the last, which?

Are you STD free?

If no, what have you been diagnosed with?

When was the last time you were tested?

Please list any health problems or injuries you may have:





__Dominant but Curious

Have you ever been Dominated?

Have you ever served a Dominant regularly over any length of time?

Describe in full detail in which ways you served these Dominants:


What talents or special skills do you have that might be of service me?


How will my domination of you make my life better?


How will my domination of you make your life better?


Why do you want to serve me and not someone else instead?


Describe in detail your favorite fantasy to masturbate to: