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Therapy Application: New Patient Intake Form
All patients must have already purchased their $60 therapy session fee on Throne.
Applications sent without paying for therapy will be DENIED. Answer all questions as thorough and detailed as possible. If a written answer doesn't apply to you, type N/A. Results will be discussed and expanded on during your first therapy session.
The more I know, the better I can get into your head, the better I can help you. The more I understand you, the better your therapy treatment results will be.
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Have you paid your $60 therapy session fee?
Yes
No
Clear selection
What shall I call you? You can make up a name to remain discrete. You will use this name on throne when paying for your therapy sessions and anything else, so I know it's you.
Your answer
What is the name you used to send on Throne? So I know it's you. Don't send as "anonymous."
Your answer
What is your telegram?
*We will use Telegram to interact because I prefer to send audio notes/voice messages as I find it more hypnotic and effective*
Your answer
What are your social media handles? Specifically, your reddit, twitter usernames.
Your answer
How old are you?
Your answer
What country do you live in and what is your time-zone?
What times are you generally available for therapy and communication?
Your answer
Are you single?
Yes
Yes, and a virgin
No, married or girlfriend
Clear selection
If yes, does she know about your kinks/fetishes and online debauchery?
Yes
No, it's a secret
I'm single
Clear selection
What is your sexual experience with women? If you're a virgin, write N/A. How many women have you slept with? What kind of sexual things did you do? Was it vanilla? Did you enjoy it? Did you wish it was femdom instead of vanilla? Did something embarrassing happen? Be very detailed and descriptive. If you've had multiple partners, tell me your favorite sexual encounters and explain what you liked about them.
Your answer
What symptoms apply to you?
I want to understand your mental state. Be honest.
Depression
Anxiety
Social Anxiety / Trouble socializing
Shame
Regret/Remorse/Shame after kinky sessions or paying findoms
Hopelessness, feeling like you'll never be normal or stop being addicted to your fetishes
Feeling like you'll never be able to have a vanilla relationship or life in real life
Worried people will find out about your fetishes/kinks or online habits
Other:
What are ALL of your fetishes, kinks, and turn ons? Make sure to emphasize your top 3 favorites, while still listing ALL of the rest. Not just fetishes but every thing that turns you on. I want to know it ALL. Everything about a woman or BDSM/findom/femdom that excites you.
Your answer
What age did you discover femdom/BDSM/findom? How and where did you discover it?
Your answer
Are you embarrassed or ashamed of your kinks?
Yes
No
Clear selection
What is your experience as a submissive? Include how many (approximately) Domme's you've served, what they made you do, and describe your relationship and dynamic with them. Make sure to mention your favorite Domme's and explain why and how they became your favorite(s).
Your answer
Were either of your parents submissive (as a personality trait)
Yes
No
Maybe
No idea
Clear selection
Were you ever bullied?
Yes
No
Maybe
Clear selection
Do you feel like your real life and vanilla life is good? Is there areas you'd like to improve in or work on?
Your answer
Do you want to use therapy to enforce healthy habits, such as being forced and held accountable to exercise, diet, eat healthy, stop watching porn or masturbating, or make other positive changes/habits and routines?
Yes
No
Maybe
Clear selection
If yes to using therapy to enforce healthy habits, what healthy habits do you want to implement into your life?
Your answer
What result do you hope to achieve from therapy? Quitting? Feeling less guilt? Self understanding and self acceptance? What is your ideal outcome and goal from therapy.
Your answer
What is your weekly/monthly budget for this? What is your current financial situation?
Include your salary (how much you make) and your weekly/monthly spending limits.. aka your budget for therapy/kink
and any other relevant or financial information.
*Telling me how much you make and how much you're comfortable spending weekly/monthly allows me to pace accordingly. Budgets, limits, and boundaries are important!*
Your answer
How often do you wish to have a therapy session? I recommend at least ONE PER WEEK.
Your answer
How often do you masturbate and how often do you watch porn?
Your answer
What are your HARD limits? Example: Other men, CBT, Blood, Scat, etc.
Your answer
How often do you pay Domme's online, whether that be findoms or buying content or sessions.
Your answer
How do you feel about yourself? Be honest.
Your answer
Are you shy?
Yes
No
A bit
Clear selection
Do you think you're physically attractive?
Yes
No
Maybe
Clear selection
Are you confident talking to women?
Yes
No
Clear selection
Have you experienced any trauma?
Yes
No
Other:
Clear selection
Do you often feel bored?
Yes
No
Maybe
Clear selection
Have you ever been in love? (Even if they didn't love you back)
Yes
No
Maybe
Clear selection
Do you feel lonely?
Yes
No
Sometimes
Clear selection
Do you hate yourself?
Yes
No
Sometimes
Clear selection
Do you struggle to commit?
Yes
No
Maybe
Clear selection
Do you wish you had friendship or companionship? Someone to talk to.
Yes
No
Clear selection
Do you play video games?
Yes
No
Clear selection
If yes to playing video games, which ones?
Your answer
Do you have any interest in having a personal and private journal and writing in it for only you and me to read? It's a great tool for expression and extremely effective in therapy.
Yes
No
Maybe
Clear selection
What are some things you'd like to change about yourself?
Your answer
What do you enjoy most and find the most fulfilling when submitting to a Domme?
Your answer
Do you enjoy being assigned tasks? Would you enjoy homework and being given assignments to immerse yourself in therapy?
Yes
No
Maybe
Clear selection
Do you think you'd benefit from serving a long-term Domme you had a real connection and relationship with that wasn't just ALL about findom/bdsm/money?
Yes
No
Maybe
Clear selection
What are your hobbies, interests, and passions both online and in real life?
Your answer
Do you have any goals? If not, do you wish to establish and make goals through therapy?
Your answer
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