EmailMe Form - Session Intent Form.

Personal Information
Name *
First Last
Preferred Name
Only if different from name provided above.
Pronouns *
he/him/his
she/her/hers
they/them
other (detail below)
Everyone has pronouns, specify the ones you prefer.
Age *
Gender *
Phone *
(xxx) xxx-xxxx. If Whatsapp is used, change country code.
Email *
This must be an email that is reachable by Madame.
BDSM Experience and Interests
Session Experience *
None/Little
1-3 Dommes
4-9 Dommes
10+ Dommes
Interests
Pain
AB/DL
Bondage
Edgeplay
Surveillance
Gender Roleplay
Other Types of Roleplay
Financial Domination (online)
Financial Domination (in-person)
Bad Girlfriend/Shopping Spree
Service (as a maid/butler)
Other (detail below)

Tolerance

Pain
Bondage
Breath Play
Trampling
Humiliation
Feminization

Describe an ideal session
600 Character Limit; Email if more is necessary.
Best and Worst BDSM Experiences
Other Information
Use this space to describe anything you want Madame to know.
Quirks and Liabilities
Physical Health Issues
Write "N/A" if you truly have no physical health issues.
Mental Health Issues
Yes
No
Other (explain below)
Mental Health Issues:
Explain if 'Yes' or 'Other' were checked.
Are you neurodiverse?
Neurodivergent umbrella is fairly large; please choose wisely.
Appearance
Upload a picture
Recent pictures are best.

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