Instructions Other instructions on other pages are in RED The finished survey should look something like this

Type of Play Abrasion Age play Anal plug (public, under clothes) Anal plugs (large) Have you done this Y/N

Y N Y N

How Willing You Are 0-5 or NO Notes NO yes you have done this, it is a Hard Limit an 0 No you havent done it you think it would be 3 yes you have don this and would like to aga 5 No you havent done it you think it would be

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Instructions

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Essay

Read and think about these, then fill out the rest of the survey so you are in the proper mindset, then come back and answer these, use you What is pain, and its role in a scene to you?

Do you expect to orgasm?

How sexual do you expect a scene to be?

How do you feel about marks? Do you want them? Where can they be?

Do you have any health concerns?

Do you have an past trauma that might come up?

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Essay

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Survey Type of Play Abrasion Age play Anal plug (public, under clothes) Anal plugs (large) Anal plugs (small) Anal sex Animal roles Arm & leg sleeves (armbinders) Aromas Asphyxiation Auctioned for charity Ball stretching Bathroom use control Beastiality Beating (hard) Beating (soft) Being bitten Being serviced (sexual) Blindfolds Bondage (heavy) Bondage (light) Bondage (multi-day) Bondage (public, under clothing) Boot worship Branding Breast whipping Breast/chest bondage Breath control Brown showers (scat) Bruises Cages (locked inside of) Caning Castration fantasy Catheterization Cattle prod (electrical toy) Cells/Closets (locked inside of) Chains Chamber-pot use Chastity belts (multi-day) Chastity belts (short term) Chauffeuring (driving) Choking Chores (domestic service) Clothespins Cock rings/straps Cock worship Collars (worn in private) Collars (worn in public) Competitions (with other Subs) Corsets (trained waist reduction) Corsets (wearing casually) Cross-dressing Cuffs (leather) Cuffs (metal) Cutting Diapers (soiling) Diapers (wearing) Diapers (wetting) Dilation Dildoes Double penetration Electricity Enemas (for cleansing) Enemas (retention/punishment) Enforced chastity Erotic dance (for audience) Examinations (physical) Exercise (forced/required) Exhibitionism (friends) Exhibitionism (strangers) Eye contact restrictions Face slapping Facials (sexual) Have you done this Y/N How Willing You Are 0-5 or NO Notes

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Survey Fantasy abandonment Fantasy gang-rape Fantasy rape Fear (being scared) Fisting (anal) Fisting (vaginal) Flame play Following orders Food play (cucumbers, sorbet...) Foot worship Forced bedwetting Forced dressing Forced eating Forced heterosexuality Forced homosexuality Forced masturbation Forced nudity (around others) Forced nudity (private) Forced servitude Forced smoking Full head hoods Gags (cloth) Gags (inflatable) Gags (phallic) Gags (rubber) Gags (tape) Gas masks Gates of Hell (male) Genital sex Given away to another Dom (perm) Given away to another Dom (temp) Golden showers Gun play Hair pulling Hairbrush spankings Hand jobs (giving) Hand jobs (receiving) Harems (serving w/other subs) Harnessing (leather) Harnessing (rope) Having clothing chosen for you Having food chosen for you Head (give fellatio/cunnilingus) Head (recv fellatio/cunnilingus) High heel wearing High heel worship Homage with tongue (non-sexual) Hoods Hot oils (on genitals) Hot waxing Housework (doing) Human puppy dog Humiliation (private) Humiliation (public) Hypnotism Ice cubes Immobilization Including others Infantilism Initiation rites Injections Interrogations Intricate (Japanese) rope bondage Kidnaping Kneeling Knife play Leather clothing Leather restraints Lectures for misbehavior Licking (non-sexual) Lingerie (wearing) Manacles & Irons Manicures (giving) Massage (giving) Page 2

Survey Massage (receiving) Medical scenes Modeling for erotic photos Mouth bits Mummification Name change (for scene) Name change (legal, permanent) Nipple clamps Nipple play/"torture" Nipple rings (piercings) Nipple weights Oral/anal play (rimming) Orgasm control Orgasm denial Outdoor scenes Outdoor sex Over-the-knee spanking Pain (medium) Pain (mild) Pain (severe) Persona training (in scene) Personality modification (RL) Phone sex (commercial provider) Phone sex (serving Dom) Phone sex (serving Dom's friends) Piercing (permanent) Piercing (temporary, play-pierce) Plastic surgery Pony slave Prison scenes Prostitution (actual) Prostitution (public pretense) Public exposure Punishment Scene Pussy worship Pussy/cock whipping Religious scenes Restrictive rules on behavior Riding crops Riding the "horse" (crotch torture) Rituals Rope body harness Rubber/latex clothing Saran wrapping Scarification Scratching - getting Scratching - giving Sensory deprivation Serving Serving as a maid Serving as art Serving as ashtray Serving as furniture Serving as toilet (feces) Serving as toilet (urine) Serving as waitress/waiter Serving orally (sexual) Serving other doms (supervised) Serving other doms (unsupervised) Sexual deprivation (long term) Sexual deprivation (short term) Shaving (body hair) Shaving (genital hair) Shaving (head hair) Skinny-dipping Sleep deprivation Sleepsacks Slutty clothing (private) Slutty clothing (public) Spandex clothing Spanking Speculums (Anal) Speculums (vaginal) Speech restrictions (when, what) Page 3

Survey Spitting Spreader bars Standing in corner Stocks Straight jackets Strap-on-dildos (penetrated by) Strap-on-dildos (sucking on) Strap-on-dildos (wearing) Strapping (full body beating) Supplying new partners for Dom Suspension (horizontal) Suspension (inverted) Suspension (upright) Swallowing feces Swallowing semen Swallowing urine Swapping (with one other couple) Swinging (multiple couples) Tampon Training (in ass) Tattooing Teasing TENS Unit (electrical toy) Thumbcuffs (metal) Tickling Triple penetration Uniforms Urethral Sounds (metal rods) Vaginal dildo Verbal humiliation Vibrator on genitals Video (recordings of you) Video (watching others) Violet Wand (electrical toy) Voyeurism (watching others) Voyeurism (your Dom w/others) Water torture Waxing (hair removal) Wearing symbolic jewelry Weight gain (forced) Weight loss (forced) Whipping Wooden paddles Wrestling

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Survey

READ THIS COLUMN FIRST

Just answer the questions instinctivly, it is not important to have a 'correct' answer, the idea is more to see what you really enjoy, what you dont really care about an Willingness quick-key: ? - Don't understand this item. * - I will do with current sex partner only. NO - I WILL NOT DO that item under ANY circumstances (a hard limit). 0 - No desire, don't like, will permit if special to Dom (a soft limit). 1 - Don't want to do, but will. 2 - Willing to do, but has no special appeal. 3 - Usually LIKE doing, on an irregular/ occasional basis. 4 - LIKE doing, would like it on a regular basis. 5 - WILD TURN-ON, would like it as often as possible.

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