Name
*
First Name
Last Name
Pronouns
*
Date of Birth
*
MM
DD
YYYY
Phone Number
*
(###)
###
####
How did you hear about Me?
*
Instagram
Twitter
FetLife
Tryst
Dickie Virgin
How will you verify your age and identity?
*
I am willing to furnish a picture of valid governmemt ID
I am willing to share my LinkedIn or company profile with you
I am willing to show you my ID over our paid vetting call
I am not and therefore unworthy of Your time, Domina
Have you see a professional Dominatrix in-person before?
*
Yes, Domina
No, Domina
Reference Information
*
What names do you like to be called?
*
Choose as many as you like
Please select any additional experiences below:
Preferred Session Length
*
1 Hour
1.5 Hours (Recommended for first time clients)
2 Hours
3 Hours
4+ Hours
Where would you like to serve Me?
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NYC - Incall
DC - 4/11-4/13
What are your desires for the session? Are there any specific interests you would like to explore?
*
How do you want to feel during and/or after the session?
*
Choose as many as applies
For Social Outings
Choose which outing you'd like
Please describe any hard or soft limits/triggers.
*
This can include names you do not want to be called, hesitations, traumas you don't want brought up, etc.
Please describe any physical limitations, disabilities, allergies, or injuries I should take into consideration.
*
Additional Notes
Have you fully read My Protocol and Hard Limits?
*
If not, please click on the Protocol and Offerings links in the menu and read in its entirety.
Please check this box if you would like to join my email list.
I don't send any spam, only periodic updates or news related to Me.
