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. 
Sign in to Google to save your progress. Learn more
Have you paid your $60 therapy session fee?
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.
What is the name you used to send on Throne? So I know it's you. Don't send as "anonymous."
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*
What are your social media handles? Specifically, your reddit, twitter usernames.
How old are you?
What country do you live in and what is your time-zone?

What times are you generally available for therapy and communication?
Are you single?
Clear selection
If yes, does she know about your kinks/fetishes and online debauchery?
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.
What symptoms apply to you? 

I want to understand your mental state. Be honest.
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. 
What age did you discover femdom/BDSM/findom? How and where did you discover it?
Are you embarrassed or ashamed of your kinks?
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).
Were either of your parents submissive (as a personality trait)
Clear selection
Were you ever bullied?
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?
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?
Clear selection
If yes to using therapy to enforce healthy habits, what healthy habits do you want to implement into your life?
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.
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!*
How often do you wish to have a therapy session? I recommend at least ONE PER WEEK. 
How often do you masturbate and how often do you watch porn?
What are your HARD limits? Example: Other men, CBT, Blood, Scat, etc.
How often do you pay Domme's online, whether that be findoms or buying content or sessions.
How do you feel about yourself? Be honest.
Are you shy?
Clear selection
Do you think you're physically attractive?
Clear selection
Are you confident talking to women?
Clear selection
Have you experienced any trauma?
Clear selection
Do you often feel bored?
Clear selection
Have you ever been in love? (Even if they didn't love you back)
Clear selection
Do you feel lonely?
Clear selection
Do you hate yourself?
Clear selection
Do you struggle to commit?
Clear selection
Do you wish you had friendship or companionship? Someone to talk to.
Clear selection
Do you play video games?
Clear selection
If yes to playing video games, which ones?
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. 
Clear selection
What are some things you'd like to change about yourself?
What do you enjoy most and find the most fulfilling when submitting to a Domme?
Do you enjoy being assigned tasks? Would you enjoy homework and being given assignments to immerse yourself in therapy?
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?
Clear selection
What are your hobbies, interests, and passions both online and in real life?
Do you have any goals? If not, do you wish to establish and make goals through therapy?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report