Copy and paste the application  into an email (slave will possibly need to change the color of the text), answer the questions and email to MistressJorja@gmail.com.  The spacing does not determine the length of your answers. It is essential that you provide scrupulously accurate answers so I can realistically assess your personality, wants and needs, as well as whether I need to address other issues besides your desire to serve. If you are unable to wholeheartedly give this your focused attention and be honest with your answers, do not waste my time or yours. you can choose more than one answer. There are no limits,just be completely honest. If you have never had training or experience, answer with "i am an untrained slave Mistress" and skip to the next question. Do not leave any questions blank. None.

 

Date completed:

slave name:

Contact email:

Country located in:

​

​

Part One: General

​

1. How many years of experience do you have in BDSM?

2. What is your sexual orientation?

    a. heterosexual exclusively

    b. bisexual

    c. bi curious

    d. open to training controlled by my Mistress?

3. Main interest

    a. sensual and physical

    b. psycho sexual and mental

    c. both equally

    d. serving your Mistress

4. Are you… (rate each from 1=lowest to 10=highest) if an explanation is necessary, do so. 

    masochistic       

    submissive      

5. Your level of interest in bondage:

    a. total helplessness

    b. light bondage

    c. not my favorite thing

    d. outside my limits

    e. never tried it

6. Pain (what you are, or what you are looking for)

    a. pain slut

    b. whipping, caning, paddling

    c. light paddling, sensual whipping, no marks    

    d. not interested

7.  Do others know you are submissive? Do you hide this side of yourself from others?

8. my favorite sexual fantasy is….?

9. Describe the following areas that you have endured. 

    a. wearing a full hood

    b. ass play

    c. bondage 

    d. whipping 

    e. pegging

10. Describe one area not mentioned, if any, you have endured.

11. Tell me of your sexual energy ?

    a. i like sex anytime i can get it with multi-partners.

    b. i like sex, but there are other things that are just as important to me.

    c. i like it about three times a week.

    d. once a week is enough for me.

    e. i can live without sex. It is a low priority in my life.  Serving is more important.

    f. i like sex, however i like it in my relationship, outside of a relationship i can live without it. 

​

​

​

Part Two:  Experience

 

For each item, you need to provide TWO(2) answers:

For experience, write YES or NO next to each item to indicate if you have ever DONE that activity.

For willingness, indicate for each item how you feel about DOING that activity by rating it on a scale of NO or 0 to 5 (if you don’t understand what the item is attempting to describe look it up. Do not leave any blank answers or ?'s.

NO means you will NOT do that item under any circumstances (a hard limit) and that you have absolutely no desire to do this.

0 (zero) indicates you have utterly no desire to do that activity and don’t like doing it (in fact, may loath it) and would ordinarily object to doing it, but you would permit the Mistress to do it if  She truly wanted it. (a soft limit).

1 means you don’t want to do or like to do this activity, but wouldn’t object if it was asked of you.

2 means you are willing to do this activity, but it has no special appeal for you.

3 means you usually like doing this activity, at least on an irregular/occasional basis.

4 means you like doing this activity, and would like to experience it on a regular basis.

5 means the activity is a wild turn-on for you and you would like it as often as possible.

 Note any additional information or nuances which might be important for your Mistress to know.

 

Anal sex (top) :

Anal sex (bottom) :

If so, ever without condoms?:

Anal plugs (small) :

Anal plugs (large) :

Anal plug (public, under clothes):

Animal roles :

Arm & leg sleeves (arm binders) :

Asphyxiation :

Ass licking (giving):

Ass licking (receiving):

Biting:

Being bitten :

Blindfolds :

Ben wa balls or kegel balls:

if yes how long did you wear?

Breath control :

Branding :

Bondage (light) :

Bondage (heavy) :

Bondage (multi-day) :

Bondage (public, under clothing) :

Cages (locked inside of) :

Caning :

Cattle prod or stun gun (electrical toy) :

CBT:

Cells/Closets (locked inside of) :

Chains :

Chastity belts :

Clothespins :

if you have had them used where?:

Cock sucking:

Do you swallow?:

Collars (worn in private) :

Collars (worn in public) :

Cuffs (leather) :

Cuffs (metal) :

Denied privacy:

describe the denial:

Double Penetration (anal and mouth):

Dildos :

Eating Cunt:

Electricity :

Enemas (for cleansing) :

Enemas (retention/punishment) :

Enforced chastity :

Erotic dance (for audience):

Erotic dance (private) :

Examinations (physical) :

Exercise (forced/required) :

Exhibitionism :

Eye contact restrictions :

Face slapping :

Fear (being scared) :

Fisting (anal) ::

Foot worship :

Forced masturbation :

Forced nudity (private) :

Forced nudity (around others) :

Forced servitude :

Full head hoods :

Gags (cloth) :

Gags (inflatable) :

Gags (phallic) :

Gags (rubber) :

Gags (tape) :

Given away to another Mistress (temp) :

Servicing another Mistress upon command:

Hairbrush spankings :

Hair pulling :

Hand jobs (giving) :

Harnessing (leather and or rope) :

Homage with tongue (non-sexual) :

Hoods :

Hot Creams (Ben-Gay) on genitals:

Hot oils (on genitals) :

Hot waxing :

Housework (doing) :

Human puppy dog :

Humiliation :

Ice cubes :

If you have experienced, where?: (nips, ass)

For impact play list your general answer, then answer for the different types of elements.

Immobilization :

If so, how?

Impact play :

Rough body play (punching, kicking, open hand face slapping, etc.) :

Spanking (hand, paddles, strops, slappers, belts, etc.) :

Caning (batons, canes, sjambok, etc.) :

Flogging (cat-o-nine, galley-whip, quirt, flogger, etc.) :

Single tail (snake-whip, signal-whip, bullwhip, etc.) :

Leather restraints :

Manacles & Irons :

Massage (giving) :

Massage (receiving) :

Modeling for erotic photos :

Photographing  training sessions with your Mistress:

Mouth bits :

Multi-partners:

Mummification :

Nipple clamps :

Nipple rings (piercing):

Nipple play/”torture” :

if a type not listed then explain:

Nipple weights :

Obeying verbal commands such as “kneel”,  “stand” or “Present.”

Oral/anal play (rimming):

Over-the-knee spanking :

Orgasm denial :

Orgasm control :

Outdoor scenes :

Outdoor sex :

Pain (severe) :

Pain (mild) :

Piercing (temporary, play-pierce):

Piercing (permanent) :

Punishment Scene :

if yes, describe the scene play

Cock & ball torture:

describe torture:

Restrictive rules on behavior :

Rubber/latex clothing :

Rope body harness :

Role playing:

Saran wrapping :

Sensory deprivation :

Serving as furniture :

Serving as a maid :

Serving orally (sexual) :

Serving another Mistress (supervised) :

Serving another Mistress (unsupervised):

Serving others as sex slave:

Shaving (body hair) :

Shaving (head hair) :

Slave positions training:

Spandex clothing :

Spanking :

Speech restrictions (when, what) :

Spreader bars :

Stocks :

Straight jackets :

Strapping (full body beating) :

Strap-on dildo receiving:

Strap-on dildo giving:

Suspension (upright) :

Suspension (inverted) :

Suspension (horizontal) :

Supplying new partners for Mistress:

Swallowing semen:

Swapping (with one other couple) :

Tattoos:

TENS Unit (electrical toy) :

Tickling :

TPE : 

Uniforms :

Vibrator on genitals :

Violet Wand (electrical toy) :

Voyeurism (watching others) :

Video (watching others) :

Video (recordings of you) :

Waxing (hair removal) :

Whipping :

Wooden paddles :

​

Was there something not on the list?

​

1. What are your known hard limits? 

(anything listed as a No in part 3 should be listed here) 

2. What are your known soft limits?

(anything listed as a 0 in part 3 should be listed here)

3. What are your top three favored?

(OTK spanking, flogging, spreader bars, ...etc.)

​

​

Part Three:  Health

​

​

1. Do you smoke? If so, amount per day?

2. Do you drink? How often? Amount?

3. Do you use drugs? Prescription? Other drugs?

4. Do you have problems controlling your temper?

5. Have you been in a drug abuse program?

6. Have you been diagnosed with mental problems?

Describe:

7. Do you have any disabilities (visible or invisible)?

Describe:

8. Do you wear glasses or contact lenses?

9. Do you have any special dietary needs or restrictions?

10. Are you allergic to dogs, cats, or other animals? 

11. Do you have any sexually transmitted diseases? Can you provide an STD screening report from your doctor?

12. Do you have any tattoos or piercings?

13. Do you have problems reaching orgasm?

14. What is the most you have ever cum in a 24 hour time period?

Describe circumstances.

15. How often do you masturbate and what methods do you use?

16. Are you subject to any form of loss of conscience or seizures?

17. Do you have panic attacks or phobias?

18. Do you now or have you suffered from depression?

19. What was your last illness that resulted in hospitalization and when?

20. Have you had any major surgeries?

21. Do you have any medical conditions? 

22. Are you on any medications?

Be aware that simple things such as use of hormone treatments, blood pressure medication, iron deficiencies and similar illness or medications can cause a much higher risk of leaving marks and that no impact play of any kind is completely risk free from leaving marks and sometimes bruises may arise days later when they were not present previously.

 

Do you have anything else to add or any questions related to this questionnaire?