Sample Intake Form

Here is an example of what an intake form might look like. Of course, everyone will fill it out in their own specific way. It’s important to think this through carefully beforehand and include points that are important to the Dominant in question.

BDSM Intake Form

Name:

What is your desire?
Femdom SM Ageplay Kinky sex Medical
Sexual activities:
Oral
Anal

Experience:
Extensive
Moderate
Limited
First time

Medical information:
Blood thinners
Heart conditions
Blood disorders
Diabetes

Safeword:

Additional details (fetish, kinks, play style, preferences, no-go’s, marks yes/no):

House Rules

Hygiene:
All equipment is cleaned after each session according to a hygiene protocol.
Alcohol / Drugs / Poppers:
This studio has a zero-tolerance policy regarding alcohol and drugs. The use of poppers is also not allowed.
Respect & form of address:
The Mistress is to be addressed as Mistress and in a respectful formal manner.
Other agreements: