Pre-Negotiation Form
Instructions for use: Click and drag across to highlight
this entire page, then go to Edit and copy it. Open a new
page by selecting File, then New and then paste the text onto
the sheet and give it a name. After you have filled in your
responses, repeat the copy paste process and e-mail it to
your recipient. Play Safely!! Best Wishes!! SS : )
All information should be kept confidential
Part 1 General Information
Real Name:
On-Line Nick:
E-mail address:
Age:
Phone:
Address:
Location (city/state):
(Please note: while I caution anyone to be careful giving
personal info such as name, phone and address to those you
do not know well, I do strongly advise that you obtain it
from others before meeting someone in person and provide this
info to a safety [see Newbie Guide])
For the following questions delete the answers that do not
apply:
1. SM experience:
a) novice
b) cyber only
c) experienced
2. Gender:
a) male
b) female
c) crossdresser
d) transsexual
3. Sexual Orientation:
a) heterosexual
b) bi-curious
c) bisexual
d) gay
4. Preferred Power Position:
a) dominant
b) submissive
c) switch
5. BDSM Interest:
a) physical- sensation pain/pleasure
b) psychological- mental such as role-play
c) both are equally important
6. Do you feel service is a vialble part of BDSM (cleaning,
errands etc)?
a) Hell yes make me serve!!
b) To a degree in as much as it is good to help out my dominant.
c) It can add to the fantasy as long as it is wiht in reason.
d) No Not at all if I wanted to clean I would get a job as
a maid!!
7. Is punishment something you seek in BDSM?
a) I’ve been a bad little subbie and don’t deserve
anything but a good beating
b) Yes it can add to the Power exchange but don’t push
it too far
c) In the right time and right place but not too often
d) Punishment? No!! I am not here for you to take your aggressions
out on.
8. What, if any, marks are acceptable?
a) Beat me till I beg for more then stop just cause you can.
b) If it is red for a week so be it it reminds me of you.
c) Accidents happen but not too often
d) Red for a few hours is OK but only for a few hours
e) If I leave with so much as a red hand print call you lawyer
you’ll need him
9. Does anyone know about your intrest in BDSM?
a) I am Pervert hear me scream!!!!!
b) There are a few close friends and family that know.
c) SHHHHH!!!!!!! Don’t say that too loud someone might
hear!
Part 2 Role Play
List any role fantasies you may have such as teacher/student,
nurse/patient etc.
Fetishes (Eg: feet, boots, leather etc.):
Part 3 Health Issues
Medical / Emotional / Physical Concerns: (please
list past sprains (recent), breaks, chronic conditions or
phobias)
Also please inform me of any issues that you feel may cause
a potential trigger or bad reaction: (rape, incest, child
abuse, race concerns or anything that makes you very uncomfortable.)
Are there any particular areas you feel you would like to
challenge or explore? (describe you idea of an ideal scene)
Part 4 Humiliation Verbal and Physical:
What types of humiliation are acceptable to you?
Verbal:
Other:
Part 5 Preferred Activities
Below is a list of some typical scene activities. Pick a
number from 1-10 and place it beside the item number.
1 meaning "eeeeeeekk run away" 10 being "OH
Yes baby please do it again and again!!" If you are unsure
about either the effect or what something is please place
a ? next to it.
Keep in mind that not all these activities will be included
all the time and that none are mandatory.
Corporal:
__1)spanking (hand)
__2)leather paddle
__3)wooden paddle
__4)belt/strap
__5)deerskin cat
__6)leather cat
__7)braided cat
__8)rubber whip
__9)knotted whip
__10)single lash
__11)riding crop
Bondage:
__1) mental bondage
__2) silk scarves
__3) nylon rope
__4) chains
__5) leather bonds
__6) plastic wrap
__7) gags
__8) leather cuffs
__9) breast bondage
__10) genital bondage
__11) spreader bars
__12)ceiling/wall hooks
__13) slings/swings
__14) crosses
Torture & Sensory Deprivation:
__1) blindfolds
__2) hoods
__3) headphones earplugs etc.
__4) feathers and fur
__5) tickling
__6) sexual teasing
__7) pinching
__8) hair pulling
__9) nipple clips
__10) clothes pins
__11) genital torture
__12) weights
__13) ball stretchers
__14) ice
__15) oils, lotions, spices
__16) hot wax
Humiliation & Exhibition:
__1) foot kissing
__2) kneeling
__3) crawling
__4) lead on a leash
__5) dirty words
__6) verbal abuse
__7) pub. embarrassment
__8) face slapping
__9) cross dressing
__10) public display
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