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Ruby la Rouge BDSM Client Form
Please read the Terms of Agreement for New Clients and complete the following form to schedule an appointment.
This form will take between 15-45 minutes to complete.
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* Required
Email
*
Your email
Scene Name or Nickname
*
Your answer
Phone number
Your answer
Gender
*
Male
Female
Non-binary
Other:
Role
*
Choose
Submissive
Slave
Pet
Little
Masochist
Switch
Pain tolerance
*
Choose
High (9-10)
Medium (5-8)
Low (1-4)
Sexual preference
*
Choose
Straight
Bisexual
Pansexual
Gay/Lesbian
Asexual
How easy is it for you to achieve an orgasm?
*
Easy
Moderate
Difficult
How easy is it for you to achieve an erection (or to become aroused for those who identify as female)?
*
Easy
Moderate
Difficult
Allergies:
*
Your answer
Physical Impairments: (eg. bad back, epilepsy, etc)
*
Your answer
Phobias/Abuse Issues:
*
Your answer
Preferred Method of Contact for Consultation:
*
Phone
Email
In person
Zoom call
Other:
Required
Type of Scene Desired:
*
Dungeon (currently unavailable)
Online (webcam)
Phone call
Public setting
Out call (local)
Out call (interstate)
Out call (international)
Required
How experienced are you with BDSM?
*
Choose
Brand new (First time)
Played once or twice
Regular player
Experienced player
How did you hear about me?
*
Fetlife
Red escorts
Web search
Other:
Which services interest you?
*
1 Session
Domestic servitude
Slave training
Consultation only
Other:
Required
Permission to be photographed for advertising purposes?
*
Yes
No
Yes, but conceal my identity (no face/tattoos/other visible identifiers)
Have you ever had a bad experience with a Dom?
*
Yes
No
Required
If so, what went wrong/How can I do things differently?
Your answer
Specific Clothing/Toy/Activity/Equipment Requests: (optional)
Your answer
Comments and/or Additional Information: (optional)
Your answer
Anal: (if of interest, select all that apply)
Butt plugs
Dildos
Enemas
External massage (rimming)
Fisting (gloved only)
Prostate milking
Vibrators
Strap-on
Bondage: (if of interest, select all that apply)
Chains
Rope
Cuffs
Genital bondage
Mummification
Restraint Duration (0-1 Hour)
Restraint Duration (Over 1 Hour)
Genitorture, Cock & Ball Torture or Vaginal Torture (if interested, select all that apply)
Abrasion
Bondage
Catheters/sounds (internal)
Chastity device
Clothespins
Crushing (no permanent damage)
Kneeing (groin)
Slapping
Weights
Discreet Public Play: (if of interest, select all that apply)
Bondage under clothes
Concealed Toys
Play parties
Serving with other subs
Serving multiple Dommes
Gags: (if of interest, select all that apply)
Ball type
Cloth (eg. Panties)
Rope
Tape
Material Fetish: (if of interest, select all that apply)
Balloons
Feathers
Fur
Leather
Non-Animal/vegan only
Nylons
Plastic wrap
PVC
Satin
Lace
Latex
Silk
Spandex
Nipple Play: (if of interest, select all that apply)
Light touching
Clamps - light
Clamps - moderate
Clamps - strong
Orgasm Control: (if of interest, select all that apply)
Chastity
Delayed orgasm (edging)
Forced multiple orgasm
Masturbation instruction
Ruined orgasm
Pornography/Scene Pictures or Filming (BDSM Related): (if of interest, select all that apply)
Filming
Being on camera (participating)
Taking photographs
Behind the scenes volunteering
Creating scenes (drafting)
Power Exchange: (if of interest, select all that apply)
Bathroom Restrictions
Begging
Blackmail
Clothing choice (Mistress picks)
Collars
Crawling
Diet control
Email/Online chat/Phone Domination
Eye-Contact restrictions
Kneeling
Leashes
Position Training/Mental Bondage
Protocol
Punishment scene
Servitude
Speech restrictions
Take-Home tasks
Tease and Denial
Role Playing: (if of interest, select all that apply)
Age play - baby
Age play - school age
Blackmail
Costumes
Human furniture
Inspection/physical examination
Interrogations
Office politics
Pony play
Puppy play
Stripper
Superhero/Super Villain
Sensation Play: (if of interest, select all that apply)
Ear touching
Ice cubes
Icy hot (eg. Deep Heat)
Hot wax
Massaging (on you)
Tickling
Scratching
Sensory Deprivation: (if of interest, select all that apply)
Blindfolds
Ear plugs
Sound stimulation (Music)
Sound stimulation (Other/ASMR)
Fun Domme: (if of interest, select all that apply)
Tease and Denial games
Massage (Mistress receives)
Tantra
Seductive/Naughty card games (eg. strip poker)
Naughty shopping trips
Clear selection
S&M: (if of interest, select all that apply)
Biting
Canes
Crops
Face slapping
Flogging - light
Flogging - moderate
Flogging - heavy
Foot torture
Hair pulling
Paddling
Spanking - light
Spanking - moderate
Spanking - heavy
Trampling
Verbal: (if of interest, select all that apply)
Dirty names
Dirty talk - listening
Dirty talk - performing
Praise
Story telling
If Verbal "Dirty names", please specify:
Your answer
Watersports - Urine Only: (if of interest, select all that apply)
Golden showers - body
Golden showers - face
Nectar consumption
Worship only: (if of interest, select all that apply)
Armpit
Body scent training (smelling Mistress)
Boot worship
Foot worship
Massaging - giving
Manicures - giving
Pedicures - giving
Shaving - giving
Shoe worship
Smothering
Sploshing (you provide food items)
Verbal worship (complimenting Mistress)
Miscellaneous:
BDSM homemade toy making
BDSM homemade furniture making
Enemas
Clear selection
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