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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Scene Name or Nickname
How easy is it for you to achieve an orgasm?
How easy is it for you to achieve an erection (or to become aroused for those who identify as female)?
Physical Impairments: (eg. bad back, epilepsy, etc)
Preferred Method of Contact for Consultation:
Type of Scene Desired:
Dungeon (currently unavailable)
Out call (local)
Out call (interstate)
Out call (international)
How experienced are you with BDSM?
Brand new (First time)
Played once or twice
How did you hear about me?
Which services interest you?
Permission to be photographed for advertising purposes?
Yes, but conceal my identity (no face/tattoos/other visible identifiers)
Have you ever had a bad experience with a Dom?
If so, what went wrong/How can I do things differently?
Specific Clothing/Toy/Activity/Equipment Requests: (optional)
Comments and/or Additional Information: (optional)
Anal: (if of interest, select all that apply)
External massage (rimming)
Fisting (gloved only)
Bondage: (if of interest, select all that apply)
Restraint Duration (0-1 Hour)
Restraint Duration (Over 1 Hour)
Genitorture, Cock & Ball Torture or Vaginal Torture (if interested, select all that apply)
Crushing (no permanent damage)
Discreet Public Play: (if of interest, select all that apply)
Bondage under clothes
Serving with other subs
Serving multiple Dommes
Gags: (if of interest, select all that apply)
Cloth (eg. Panties)
Material Fetish: (if of interest, select all that apply)
Nipple Play: (if of interest, select all that apply)
Clamps - light
Clamps - moderate
Clamps - strong
Orgasm Control: (if of interest, select all that apply)
Delayed orgasm (edging)
Forced multiple orgasm
Pornography/Scene Pictures or Filming (BDSM Related): (if of interest, select all that apply)
Being on camera (participating)
Behind the scenes volunteering
Creating scenes (drafting)
Power Exchange: (if of interest, select all that apply)
Clothing choice (Mistress picks)
Email/Online chat/Phone Domination
Position Training/Mental Bondage
Tease and Denial
Role Playing: (if of interest, select all that apply)
Age play - baby
Age play - school age
Sensation Play: (if of interest, select all that apply)
Icy hot (eg. Deep Heat)
Massaging (on you)
Sensory Deprivation: (if of interest, select all that apply)
Sound stimulation (Music)
Sound stimulation (Other/ASMR)
Fun Domme: (if of interest, select all that apply)
Tease and Denial games
Massage (Mistress receives)
Seductive/Naughty card games (eg. strip poker)
Naughty shopping trips
S&M: (if of interest, select all that apply)
Flogging - light
Flogging - moderate
Flogging - heavy
Spanking - light
Spanking - moderate
Spanking - heavy
Verbal: (if of interest, select all that apply)
Dirty talk - listening
Dirty talk - performing
If Verbal "Dirty names", please specify:
Watersports - Urine Only: (if of interest, select all that apply)
Golden showers - body
Golden showers - face
Worship only: (if of interest, select all that apply)
Body scent training (smelling Mistress)
Massaging - giving
Manicures - giving
Pedicures - giving
Shaving - giving
Sploshing (you provide food items)
Verbal worship (complimenting Mistress)
BDSM homemade toy making
BDSM homemade furniture making
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