Mistress Portia's BDSM Application
Application for Prodomme Session
Sign in to Google to save your progress. Learn more
Email *
Application instructions:   I take confidentiality VERY seriously (both yours and mine).  All information given is strictly confidential, for my eyes only!!!!  Please be honest.  The information will help me identify your experience, level, interests, and allow me to design a session specifically for you.  The more I know, the better your session(s) will be.  You must complete the entire application to be considered for a session.  

*To ensure scheduling consistency, beginning Feb 14th, 2026, deposits will be required when booking appointments. Thank you for understanding and respecting my time. 
You only need to fill out ONE application.  Do not submit multiple applications please.
Personal information:
Do NOT play coy little games using variations of your name, your city of residence, or other information.  I verify that you are who you say you are before I invite you into my private dungeon.  If you jack with me, I will simply reject your application.  Be forthcoming and honest, or don't bother.
Name (first & last, be honest, all info is confidential) *
City & State where you reside (do NOT need your full address) *
Phone number (numbers only, no dashes or spaces, used for verification purposes only, I will not be calling and I do NOT do over the phone applications).     *
How did you hear about my services? (what website, person, publication)  This helps me track effective advertising. *
Are you (check the option below that applies) *
Required
If you identify (gender) differently than your sex at birth, and feel it is relevant to our session, you may explain below.
Your current age *
If for couple session, please provide name of second party, relationship (married, dating, master/slave, dom/sub, or whatever applies)
Medical Information:  (Check all that apply) *
Required
Please briefly explain any of the medical conditions checked above (include known PTSD triggers).  If none were checked, simply say, "none." *
Please list all the medications you currently take.  If none, say, "none." *
What is your level of experience with BDSM? *
Have you visited a BDSM professional before (hookers do not count) *
Can you have marks? *
Do you mark easily? *
Check the box beside anything you would like to  include, or try, in a session(s)
Out of the fetish interests you checked above which ones have you actually tried before?  (If none type "none") *
If you checked CBT in the fetish interests section, please check your specific CBT interests below.
Out of the specific CBT interests you checked above which ones have you actually tried before?
Do you have any hard limits in your BDSM fetish preferences?  If yes, please list below
Please explain any additional thoughts or fetish ideas you wish me to consider below (if none, type "none'). Do not bait and switch me during a session, tell me NOW:   *
Please describe how you envision a session with me, and what that might include. (answer this in detail, I ask for good reason!!  Open communication is key.) *
Sessions/Tribute
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google.