Name
*
First Name
Last Name
Pronouns
*
Email
*
Phone Number
*
Can I text you?
*
Age
*
Where did you find me?
*
City
*
What is your profession?
*
Session Type/Length
*
-select-
1 hour
1.5 hours
2 hours
3 hours
Standard Dinner Date
Dinner and Domination
Half Day (4-6 hours)
Full Day (8-10 hours)
Overnight (8-10 hours)
Cuckolding
Double/Group Session [insert Domme(s) name below]
Other
If other, please specify
Do you have BDSM experience?
*
-select-
None
Only exposed to it by media, never experienced BDSM in real life
Only with partners, never with a Pro Domme
Some experience with a Pro Domme
Lots of experience with a Pro Domme
Other
If other, please specify
What makes you feel most submissive?
*
What are you hoping to explore with me?
*
Age Play/Big/little
Blackmail
Body Worship
Caning
CBT
Chastity
Choking
CNC
Cuckolding
Feminization/Sissification
Financial Domination
Flogging
Foot Worship
GS (+100)
Humiliation/Degradation
Interrogation
Latex Fetish
Leather Bondage
Leather Fetish
Nipple Torture
OTK Spanking
Paddling
Pet Play
Rope Bondage
Sensory Deprivation
Spitting
Tease and Denial
Whipping
Other
If other, please specify
What are your "soft" limits (things you might want to try but feel hesitant about)?
*
What are your "hard" limits (things that you absolutely will not do)?
*
In an ideal session, how will you hope to feel?
*
Euphoric
Belittled
Overtaken
Compliant
Intimidated
Afraid
Safe
Comfortable
Empowered
Useful
Embarassed
Silly
Entertained
Other
If other, please specify
Anything else that you would like me to know?
I agree that if my application is accepted I will be available for a 15-20 minute phone consultation ($60) and make a 20-50% NON-REFUNDABLE deposit via CashApp, Venmo, gift card, or drop-off to secure my session
*
-select-
Yes, Mommy!
Absolutely anything for you, my Lady.
Thank you! I appreciate your patience as I review your application and verify your references.
If I believe we may be a good fit I will be in touch shortly regarding next steps.
Warmly,
Harper