BDSM Consent & Negotiation Forms

People
Who (only) will take part?___________________________________________
Who (only) will watch?__________________________________________
Will any permanent record (photographs, audiotapes, videotapes, etc.)
be made of the session? Yes_____ No_____
Explanation__________________________________________________________
Roles
Who will be dominant?________________________________________________
Who will be submissive?______________________________________________
Type of scene:_______________________________________________________
Any chance of switching roles? Yes_____ No_____
Explanation:_________________________________________________________
Will the submissive promptly obey? Yes_____ No_____
Explanation:_________________________________________________________
May the dominant "overpower" or "force" the submissive? Yes____No____
Explanation:_________________________________________________________
May the submissive verbally resist? Yes_____ No_____
Explanation:_________________________________________________________
May the submissive physically resist? Yes_____ No_____
Explanation:_________________________________________________________
Does resistance equal a "strong yellow"? Yes_____ No_____
Explanation:_________________________________________________________
May the submissive try to "turn the tables:? Yes_____ No_____
Does the submissive agree to wear a collar? Yes_____ No_____
Explanation:_________________________________________________________
Submissive agrees to address the dominant by the following title(s):
_____________________________________________________________________
Place & Time
Location:____________________________________________________________
Who will ensure privacy?:____________________________________________
Begin at:__________ Length:________________________
Beginning signal:____________________________________________________
Ending signal:_______________________________________________________
Who will keep track of time?_________________________________________
OOPS!
Does everybody involved understand that there is some risk of
accident, miscommunication, misperception, and/or unintentional
injury? Yes___ No___
Does everybody involved agree to discuss any mishaps in a
constructive and non-blaming manner? Yes_____ No_____
INTOXICANTS
No Intoxicants!

Limits
Submissive's limits: Any problems with the heart:yes/no lungs:yes/no
neck/back/bones/joints:yes/no kidneys:yes/no liver:yes/no
nervous system/mental:yes/no
Explanation:_________________________________________________________
Is the submissive wearing contact lenses? Yes_____ No_____
Does the submissive suffer from carpal tunnel syndrome or any related
problems? Yes_____ No_____
Does the submissive have a history of seizures:yes/no diabetes:yes/no
dizzyspells:yes/no high/low blood pressure:yes/no fainting:yes/no
asthma:yes/no hyperventilation attacks:yes/no
Explanation:_________________________________________________________
Describe any phobias:________________________________________________
Submissive's other medical conditions:_______________________________
Any surgical implants (breast, face, etc.)? Yes_____ No_____
Explanation:_________________________________________________________
Is the submissive taking aspirin? Yes_____ No_____
Is the submissive taking ibuprofin, Aleve, or other non-steroidal,
anti-inflammatory drugs? Yes_____ No_____
Is the submissive taking antihistamines? Yes_____ No_____
Other medications the submissive is taking:__________________________
Is the submissive allergic to bandage tape:yes/no nonoxynol-9:yes/no
Other allergies:_____________________________________________________
In case of emergency notify:_________________________________________
Dominant's Limits: Any problems with the dominant's heart:yes/no
lungs:yes/no neck/back/bones/joints:yes/no kidneys:yes/no liver:
yes/no nervous system/mental:yes/no
Explanation:_________________________________________________________
Dominant's other medical conditions:_________________________________
Medications the dominant is taking:__________________________________
In case of emergency notify:_________________________________________
Is the dominant currently certified in First Aid and CPR:yes/no
Safety gear on hand paramedic scissors:yes/no flashlight:yes/no first
aid kit:yes/no blackout light:yes/no fire extinguisher:yes/no

SAFEWORDS
Safeword # 1 and its meaning:________________________________________
Safeword # 2 and its meaning:________________________________________
Safeword # 3 and its meaning:________________________________________
Non-verbal safewords and their meaning:______________________________
Will the "two squeezes" technique be used? Yes____ No____
Will the "extended hand" technique be used? Yes____ No____
Sex
Does any participant believe they might have a sexually transmitted
disease? Yes_____ No_____
Explanation:_________________________________________________________
Does any participant believe they might have herpes? Yes_____ No_____
Explanation:_________________________________________________________
Have participants been tested for HIV? Yes_____ No_____
Has any participant tested positive? Yes_____ No_____
Explanation:_________________________________________________________
Circle which of the following sexual acts are acceptable, cross out
not acceptable.
Masturbation: dominant to submissive | submissive to dominant |
self-masturbation by submissive | self-masturbation by dominant
Fellatio: dominant to submissive | submissive to dominant
Cunnilingus: dominant to submissive | submissive to dominant
Analingus: dominant to submissive | submissive to dominant
Vaginal fisting: dominant to submissive | submissive to dominant
Anal fisting: dominant to submissive | submissive to dominant
Vaginal intercourse: dominant to submissive | submissive to dominant
Anal intercourse: dominant to submissive | submissive to dominant
Is swallowing semen acceptable? Yes_____ No_____
Is any participant menstruating? Yes_____ No_____
Toys such as vibrators, dildoes, butt plugs, etc. be used? Yes/No
If yes, describe:____________________________________________________
Which of the above activities will involve condoms, gloves, dental
dams, and/or other barriers?
_____________________________________________________________________
_____________________________________________________________________

BONDAGE
The submissive agrees to allow (only) the following types of bondage
hands in front:yes/no
hands behind back:yes/no
ankles:yes/no
knees:yes/no
elbows:yes/no
hog-tie:yes/no
spreaderbars:yes/no
arm binder:yes/no
arm splints:yes/no
tied to chair:yes/no
tied to bed:yes/no
tied to bench:yes/no
use of blindfold:yes/no use of gag:yes/no
use of hood:yes/no
use of rope:yes/no
use of tape:yes/no useofleathercuffs:yes/no
useofhandcuffs/metalrestraints:yes/no
partialsuspension:yes/no
fullsuspension:yes/no
predicamentbondage:yes/no
mummification with plastic wrap, body bag, or similar technique:
yes/no
Any past bad experiences by either person with bondage, gags,
blindfolds, and/or hoods? Yes____No____
Explanation:_________________________________________________________
PAIN
Submissive's general attitude toward receiving pain:
____likes ____accepts _____neutral _____dislikes _____will not accept
Quantity of pain the submissive wants to receive:
_____none _____small _____average _____large
Explanation:_________________________________________________________
Dominant's general attitude toward giving pain:
____likes ____will give ____neutral ____dislikes ____will not give
Quantity of pain the dominant wants to give:
_____none _____small _____average _____large
Explanation:_________________________________________________________
Will the "nod" technique be used? Yes_____ No_____
Explanation:_________________________________________________________
Will the "one to ten" technique be used? Yes_____ No_____
The following types of pain are acceptable spanking:yes/no
paddling:yes/no flogging:yes/no caning:yes/no face slaps:yes/no
biting:yes/no nipple clamps:yes/no genital clamps:yes/no clamps
elsewhere:yes/no locations:_________________ ice:yes/no hot
wax:yes/no tickling:yes/no
Other types/methods of pain:_________________________________________
Additional
remarks:_____________________________________________________________

MARKS
Is it acceptable to the submissive if the play leaves marks?Yes__No__
Visible while wearing street clothes? Yes____ No____
Visible while wearing a bathing suit? Yes____ No____
Is it acceptable to the submissive if the play draws small amounts of
blood? Yes____ No____
Explanation:_________________________________________________________
How easy or difficult has it been to mark the submissive in the past?
_____________________________________________________________________
EROTIC HUMILIATION
The submissive agrees to accept being referred to by the following
terms:
_____________________________________________________________________
The submissive agrees to the following forms of erotic humiliation...
"verbal abuse":yes/no
enemas:yes/no
forced exhibitionism:yes/no
spitting:yes/no
water sports:yes/no
face slapping:yes/no
Other:______________________________________________________________
Any prior really good or really bad experiences in these areas?
_____________________________________________________________________
OPPORTUNITIES/SPECIAL SKILLS
Anything either party would especially like to try or explore?
Yes____ No___
Explanation:_________________________________________________________
FOLLOW-UP
(Please include a note about who will initiate contacts.)
After the session:___________________________________________________
The next day:________________________________________________________
A week later:________________________________________________________
In the event of a crisis:____________________________________________
16. ANYTHING ELSE? Yes____ No____
Explanation:_________________________________________________________
What will become of this form after the session?
_____________________________________________________________________

POST-SESSION NOTES AND FEEDBACK

Dominant Overall feeling about the session on a scale of one-to-ten
(ten tops)______
Best part of the session and on a scale of one-to-ten how good was
it?
_____________________________________________________________________
Worst part of the session and on a scale of one-to-ten how bad was
it?
____________________________________________________________________
Other
comments:_______________________________________________________
Submissive Overall feeling about the session on a scale of one-to-ten
(ten tops)_______
Best part of the session and on a scale of one-to-ten how good was
it?
____________________________________________________________________
Worst part of the session and on a scale of one-to-ten how bad was
it?
____________________________________________________________________
Other
comments:_______________________________________________________