Madam Salty Minx, Professional Dominatrix
I love to hear from those who are serious about exploring BDSM and the services I offer.

*Read all the info on my website for rules, session prep, expectations, rates, times/dates available, hard limitations, services, etc. This isn't a suggestion: www.madamsaltyminx.com  

*Do not leave a land-line or an e-mail for contact info, you will not be contacted. 
*Questions are non-discriminating and for safety & session purposes only, answer honestly & realistically.
*Please have your paypal account set-up BEFORE you contact me. Paypal is international.

Sign in to Google to save your progress. Learn more
Today's Date: (Month & Day) *
Your first name/nickname *
Age and Birth Year *
Which city & country are you located in? *
Your Cell Phone Number (text only) - or Fetlife name below to contact you. *
Gender & Pronouns  *
Your weight and your height  *
Right now, I identify as a: *
I, as a submissive, agree to the following: (If you cannot tick all in this section, please exit the application) *
Required
Do you have any medical conditions, injuries that impede mobility or problems consenting/understanding that I should be aware of for safety? (Epilepsy, heart conditions, surgery within 9 months, circulatory issues, diabetes, claustrophobia, mental health issues, etc) *
Have you had a bad experience with bdsm, or something triggers a negative response? (so I can avoid it, or we can slowly work through it) *
Have you had any experience with BDSM? *
Read & select one of the 3 options appropriate for you: (Turn your phone if there are only 2) *
I want this!
I'm not sure
NOT Interested
Rope Bondage (Floor immobilization)
Rope Bondage (Partial or full suspensions)
Light Bondage: Leather/Metal wrist/ankle Restraints
Confinement Bondage: Wooden boxes
Confinement Bondage: Sleepsack, Straitjacket, tape mummification (half or full)
Confinement Bondage: Padded Cell
Long Bondage Sessions: (5+ hours) With hydration breaks & position changes
Light Bondage Massage w/relaxing sounds
Heavy Bondage w/ Relaxing Sounds
Impact Play (Whips, canes, floggers, paddles, hand spanking, etc)
Blindfolds or Hoods
Genital Bondage/Breast Bondage
Toys (Clamps, Vibrators, pinwheel, penis pump, clothes pins)
Genital Torture/CBT
Toyed Only: Forced orgasm/Edged/Denial
Electrical Stimulation (CBT/Genital Torture)
Gags (Ring, Tape, ball, rope, etc)
Anal Play (Toys only)
Foot Torture (bastinado/binding/estim etc)
Discipline Roleplay (Pain inflicted by a superior)
Humiliation/Degradation (Verbal/Physical)
Permanent Marker (writing on body) (fades quickly with oil)
Breath Play (Light to Medium)
Breath Play (Heavy to Extreme)
Cross-Dressing/"Forced" Feminization
ASMR Personal Attention/Soft Touch
I'd like a dress up and photo session only
I'm new & looking for an intro session
No session, I'd only like to learn Rope Bondage or BDSM Safety
Tell me a few details of your biggest fantasies pertaining to a session you might like to experience. (If this involves my hard limitations/things I do not offer, mention something else.) *
What are your hard limits, if they differ from mine? *
Do you agree to send two recent photos via text or FL.  (one face with no glasses/hat & one clothed full body)  *
When were you looking to book your session? *
Ideally, how long would you like this session to last? (Must answer based on funds available) *
Are you wanting photos or video clips of your session? *
Optional: Leave a respectful personal note for me.
Thank you for taking the time to answer my questions. If you do not hear from me within 10 days, your contact info is probably incorrect. (If you are under the age of 20, I will not respond to your application. Photo ID may be required if I suspect you don't fit my age criteria.)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report