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.
You only need to fill out ONE application. Do not submit multiple applications please.
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)
Male (biologically speaking)
Female (biologically speaking)
Couple (two persons attending session whether same or opposite sex/gender)
Identify differently than your biological sex at birth
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)
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 blood 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)
History or diagnosis of Asberger Syndrome or Autism
N/A - none of the above
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?
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) Types broken down in a question to come
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)
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 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
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'):
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.)
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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