Formal Petition · New Client Form

Approach
with intention.

Detailed intake form for new clients

I Chapter 1 of 21

I Initial Information

II Waiver

III Informed Consent And Legal Notice

IV Planning Your Scene

V Safety

VI Medical

VII Physical Limitations

VIII Your Experience

IX Impact Preferences

X Anal and Balls

XI Breath Play

XII Body Part Torture

XIII Role Play

XIV Fetishes

XV Humiliation

XVI Being Forced

XVII Sensation Play

XVIII Electric Play

XIX Wax Play

XX Suspension

XXI Bondage

Chapter I

Initial Information

Letter of return ·

A confidential confirmation will be sent here. No third address is kept.

Legal First Name ·

Legal Last Name ·

Preferred Pronouns ·

Date of Birth ·

Phone Number (with any extension) ·

How should I contact you (select all that apply ·

Phone Email Leave voice mail Text

Emergency Contact Name ·

Emergency Contact Phone Number (with any extension) ·

All replies are kept in private correspondence.