Mistress Portia's BDSM Application
Application for Prodomme Session
Application instructions: I take confidentiality VERY serious (both yours and mine). All information given is strictly confidential, for my eyes only!!!! Please be honest and forthcoming with your answers. 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.
**Be smart, DO NOT use your work email or a personal account others can access if they do not know about your BDSM activities
Name (first & last, be honest, all info is confidential)
City & State where you reside (do not need 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)
Are you (check the option below that applies)
If couple, please provide name of 2nd party, relationship (married, dating, master/slave, dom/sub, or whatever applies)
Medical Information: (Check all that apply)
Post Traumatic Stress Disorder (PTSD)
History of heart disease
History of heart attack, stroke, or T.I.A.
Do you have a pacemaker
Have you had your prostate removed
History of blod clots
Do you bruise easily
Do you have any skin conditions (examples: ring worm, psoriasis, poison ivy, poison oak, sumac, open sores, boils, blisters, etc…)
Do you have mobility issues (wheel chair bound, unable to climb stairs, limited joint mobility or range of motion, etc…)
Do you currently take any medications (side effects may affect my session planning, so please be honest)
N/A - none of the above
Please list all medications you currently take. If none, say, "none."
Please briefly explain any of the medical conditions checked above (include known PTSD triggers). If none were checked, simply 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?
Only if they disappear quickly
A few hidden marks are okay
Do you mark easily?
Check the box beside anything you would like to include, or try, in a session(s)
Chastity devices (helpful if you have your own fitted to your size)
Cling film/Plastic wrap (like Saran Wrap)
CBT (cock & ball torture)
Collar & leash
Exhibitionism (we will NOT be going out in public during a session)
Feathers/Light touch sensations
Foot fetish (including trampling with or without heels, boots, etc)
High heels (on you sir)
Hoods (leather hoods)
Humiliation (more action, smart remarks, I do not practice direct degradation speech)
Masturbation (you, directed to perform the act on yourself, in front of me)
Nylon fetish (on your legs sir)
OTK Spanking (over the knee)
Paddling (spanking with paddles)
St Andrew's cross (being bound to)
Sensory Deprivation/Sensory Play (cut off sight and sound, different items used to tease your senses like hot wax, ice, crops, light touch, feathers, vampire gloves, etc)
Shoe or boot fetish
Tickling (light touch tickling or the full on tickling like when you were a child)
Vacuum Bed (immobilization/confinement/heavy bondage)
Whips (such as single tails, snake whips, bullwhips)
If you checked CBT above, please check the specific things you have tried, or may want to try.
Electroplay (tens unit, cock bands, violet wand, shock collar on your junk, etc)
Impact (crops, slappers)
Kicking or punching/Ball busting
If you checked any of the CBT options above, which ones have you actually experienced, and which are you hoping to try?
Please explain any additional thoughts or fetish ideas you wish me to consider below:
Please describe how you envision a session with me, and what that might include. (answer this in detail, I ask for good reason!!)
1 hr $250
90 min $375
2 hrs $500
longer sessions available upon request $250/hr applies to additional time as well
A copy of your responses will be emailed to the address you provided.
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