Name._________________________ Date of birth______________
Address.________________________ E-Mail address__________________
city___________ state___ zip________ Nick or scene name_______________
Phone_________________
Communication is the most important thing in any relationship, but it is even more so in a BDSM relationship. For there to be an exchange of power and control each person must be open and honest. This is with themselves as much as others.
Medical History
List all illness/injuries you are being treated for. (Heart, asthma,
blood sugar, blood pressure etc.)
List any medications both prescription and over the counter you take regularly, and what they are treating.
All allergies.
Physical limitations.
Do you exercise regularly?
What type of exercise do you get?
Anything else you feel might be important for Me to know.
Family History
Parents(include step parents)
Siblings (including step)
How would you describe your relationship to each of the members
of your family? In three sentences give me a synopsis of your
relationship with each of these different people. (We were close,
There was friction, We did/didn't get along etc.)
(use additional sheets as needed)
Are you the oldest/youngest/middle child?
What do you feel are the advantages of each position?
The disadvantages?
Educational History
Highest level of schooling you achieved (include degrees attained).
List any areas of special interest/study.
What was your favorite subject?
your least favorite?
Creative or arrtistic outlets
Other skills, talents or pursuits of note
Professional History
What is your current occupation?
What types of jobs have you held?
How long were you at each one?
What is/are your career goals both for now and long term?
Where do you see yourself in 1 year? 5 years?
What did you want to be when you grew up?
Relationship History
Tell me about your past to present relationships (ie boy/girlfriends
and spouses but not limited to sexual). A biography of your significant
others.
What were the good and bad points in each relationship?
How long did each last?
Why did they end ?
What part did you play in each one as they began and ended?
(use additional sheets as needed)
Emotional History
Is there anything that has happened in your life that might affect
your ability to serve?
Has there been major emotional upheaval such as the death of someone
close, or traumatic events such as abuse both physical and emotional
in your life?
Have you ever identified any addictions in your life( chemical,
physical, sexual)?
If yes, For how long and what has been done to recover from them?
BDSM History
How do you describe yourself? bottom__ submissive__ slave__ other__
How did you find this lifestyle or discover it in yourself?
How long have you been in this lifestyle?
Describe what it is you desire/seek from this type of relationship? What do you "want"?
What do you expect/hope to gain from serving Me?
What do you perceive your "needs" are?
What are your current limits, both hard and soft?
List any books you have read on BDSM(both fiction and non-fiction).
Which was your favorite?
Have you ever served another before? R/T? Online?
For how long?
Who can act as a reference for you?
What do you offer in service?
Why do you wish to serve Me?
Why should I select to accept this petition?
What roadblocks to your service do you know of or feel may need to be addressed?
What feelings do you have about serving alongside others?
Is there anything you would like to tell Me in addition?
This petition was not designed to be all inclusive. It is designed
to get you thinking and to aide Me in making a safe, sound decision
for both of us.This petition is not going to cover all of the
aspects and issues. There will be much discussion over these questions
and others. Your total, open honesty and willingness to COMMUNICATE
are the keys to the success or failure of this relationship and
all others. Trust is built this way. IF, I should
accept this petition I will expect you to follow these keys.
This petition was composed for individual use. It is presented black on white for easy printing. It may be modified and printed for specific relationship use. It may not used either in print or html format or for any internet distribution or printed publication. This disclaimer and D/s Web Center URL should not be deleted from ANY copy of this petition