*Last Name *Age *First  name: *Place of residence: City /State *Gender: Male Couple Female *Your phone number: Transgendered *Your email address: Height *By what means do you wish to be contacted? Phone Email Appx. weight Either or both are fine *If you selected phone, what time of day may you best be reached? *May a message be left ? *How did you hear about Mistress Carrington and what of her qualities interests you in seeing her ? *How much experience (if any) have you had with a professional Dominatrix? Do you have any BDSM experience outside of a professional session? * Describe an ideal session and /or the most exciting thing you've experienced while sessioning What would sully the experience?   Describe something from a past session that didn't work or you don't wish to experience * Describe your Limits (What you DON'T want to do) What do you fantasize about during or prior to  a session? How long have you felt this way? How did these feelings begin or evolve? What, if any, type of role play do you enjoy? Check any of the following which apply.  Feel free to check as many as you'd like: I respond best to a Domina whose demeanor is: Sensual & Seductive Strict & Forceful Maternal Friendly & Conversational Cold & Calculating Disdainful Capricious & Unpredictable Condescending Gently Controlling Highly Controlling I Don't Know I want to feel: Trained & Controlled Physically Restrained and / or Tormented Objectified Seduced & Teased Used Playful Child-like Ashamed Cared for Frightened Embarassed Dirty / Slutty Intimidated Coerced Surprised In "Sub Space" Helpless Serious Forced I don't know I enjoy  the following items and attire: Little Black Dress Mother / Housewife High Heels Leather Suit / Office Boots Corsets /Lingerie Teacher / Librarian Gloves Stockings Doctor / Nurse Vinyl /Latex Religious / Robes Military / Law Enforcement I would most likely identify myself as a: Submissive Masochist Role Player Servant Slut / Bitch Bottom Cross Dresser /Gender Bender Age Player Fetishist Slave Adult Baby Hedonist Devotee Open Mind Puppy / Kitten/ Animal Role Other: I Don't Know I am interested in the following specialties Financial Domination Role Playing Emotional Release Fetish Bondage Gender Bending Corporal Punishment Distance Training * The following addresses any health concerns which may need to be worked around.  Please select all that may apply.  Being completely honest  is for your safety and well being.  Your information is kept strictly confidential. Vison: Glasses/ Contact Lenses/ Other Hearing / Hearing Aid Neck Back Hypoglycemia (Low Blood Sugar) Diabetes Asthma Allergies Heart Problems Pacemaker High Blood Pressure Low Blood Pressure Epilepsy or Seizure Disorders Knee / Legs Arthritis Joints Mental Illness Diagnosed or Otherwise Serious Psychological Issues STDs Plates, screws, pins, prosthetics or other metal in the body Hemophelia * Please provide details on  the above selections *Have you ever fainted? If so,   please explain *List any and all prescribed medications you are currently taking, including Viagra or other stimulants. *Have you  any phobias, major traumas, or known psychological "triggers?"  If so, please explain. Describe any desires or feelings you may have about the following: Corporal Punishment / Physical Torment Bondage & Physical Restraint /Control Being Psychologically Controlled Age Regression: Objectification Humiliation Financial Gifts / Tithing Fetishes Cross Dressing / Gender Bending Animal Roles / Training Have you a date / time preference for sessions? Any additional comments or questions: * In relation to  a criminal offense, felony, or first-degree misdemeanor; have you ever been arrested, convicted, pled no contest, or are there any  charges now pending against you other than non-criminal violations?