Name:__________________________________ Date:_______________________
The purpose of this questionnaire is to help you as well as me understand you, your limits, and desires. Please fill this out as much as possible and please be honest. I can not help you achieve your desires if you can not honestly help me understand what you need & want.
If you received this via e-mail please use the highlighter tool for Microsoft Word to highlight your answers. (Use Yellow preferably) Certain sections have colors that correspond with the answers in those cases please use the color that goes with your answer. If you are answering these questions with your computer as opposed to printing and writing in answers, erase lines intended to write on and type in your answers.
Only one person should fill out this form. Even if this is something you and your spouse/mate/significant other intend to do together. Everyone has different fantasies, wants, and desires. When you are done with the questionnaire you can either e-mail it back to me at tayjon@tayjonseroticride.com or bring it with you to our meeting.
Thank You,
Tayjon
PART ONE: GENERAL QUESTIONS AND INFORMATION
A. What is your level of experience?
1. Very Experienced
2. Experienced
3. Limited Experience
4. Beginner
B. How long have you had or known of your interest?
1. As long as I can remember
2. 5 years or more
3. 1 to 4 years
4. Less than 1 year
C. What is your sexual orientation?
1. Heterosexual exclusively
2. Bisexual
3. Homosexual
4. Bi-Curious
D. What kind of relationship are you currently in?
1. Long term, live in
2. Offline, meeting often
3. Offline, meeting occasionally
4. Online only
5. Not sure yet
E. Main interest
1. Sensual & physical
2. Psychosexual & mental
3. Both equally
F. Are you…. (Rate each from 1=lowest to 10=highest)
_____sadistic
_____masochistic
_____Dominant
_____Submissive
G. Your level of interest in bondage:
1. Total helplessness
2. Light bondage
3. Not my favorite thing
4. Outside my limits
5. Never tried it
H. Pain (what you are, or what you are looking for)
1. Pain slut
2. Whipping, caning, paddling
3. Light paddling, sensual whipping, no marks
4. Punishment only when necessary
5. Interested, but never tried it
6. WAY beyond limits
I. What do you believe the purpose of pain in a session is?
1. Pain is a reward
2. Pain is a punishment
3. for training or correction only
4. Whatever pleases my partner
5. Not sure
J. Sex in a scene, for me is ….
1. An absolute must
2. Expected, unless punishment is taking place
3. An enchantment
4. Not necessary or expected
5. Out of the question
K. Which settings are you comfortable playing in?
1. Public play
2. Scene parties
3. Intimate groups of 1 to 3 other couples
4. Three way play
5. One on one
L. Who can know of your activities?
1. No one
2. A very few trusted friends
3. Other scene people
4. Doesn’t matter who knows
PART TWO: INTEREST, PREFERENCES, and LIMITS
M. Role playing. Listed below are several examples of roles to be played by Dom/me or sub. List those which you are interested in, and those you’d like to see your partner play:
Amazon |
Baby |
Barbarian |
Bitch-Goddess |
Boss |
Burglar |
Child |
Clergy |
Cowboy |
Cowgirl |
Daddy |
Doctor |
Evil Priest |
Evil Priestess |
Femme Fatale |
French Maid |
God |
Goddess |
Hooker |
Indian |
Inquisitor |
Interrogator |
Hero |
Mentor |
Mistress |
Mommy |
Nun |
Nurse |
Rapist |
Role Reversal |
Pet |
Pimp |
Pirate |
Policeman |
Pony boy |
Pony girl |
POW |
Prince |
Princess |
Principal |
Puppy |
Savage |
Secretary |
Sex Object |
Sissy |
Slave |
Slave Owner |
Slut |
Student |
Suspect |
Teacher |
Teen |
Torturer |
Victim |
Warrior |
Wild Beast |
Additional roles I’d like to play:
___________________________________________________________________________________________
Additional roles I’d like my partner to play:
___________________________________________________________________________________________
N. List any specific fetishes you have (i.e. foot worship, body types):
__________________________________________________________________________________________
O. List any medical, physical or emotional concerns (past breaks, sprains, chronic conditions, phobias):
__________________________________________________________________________________________
P. List your limits here:
_________________________________________________________________________________________
Q. List your concerns about the depth and exclusivity of a relationship:
__________________________________________________________________________________________
R. List your preferred method of birth control and avoidance of STD’s:
_________________________________________________________________________________________
S. Below are several D/S activities. Please rate each of these from 1 to 6:
1= YES!!!
2= Mmmmm, I like this
3= doesn’t excite me, but I’d do it for my partner
4= Intriguing, but scary
5= Embarrassed to admit I want this
6= ABSOLUTELY NOT!!!!!
Spanking, by hand |
Hot Wax |
Leather Paddle |
Fire and Ice |
Wooden Paddle |
Needles |
Belt or Strap |
Cutting |
Switch |
Abrasions |
Deerskin Cat o’ nine |
Electric Torture |
Leather Cat o’nine |
Digital sex |
Braided cat o’nine |
Directed masturbation |
Knotted Whip |
Vaginal Sex |
Rubber Whip |
Oral Sex |
Single lash |
Vibrators/ dildos |
Cane |
Fiberglass/Plastic Rod |
Riding Crop |
Fur-lined paddle |
Mental bondage |
Silk scarves |
Nylon rope |
Cotton rope |
Chains |
Leather Bonds |
Spandex bonds |
Plastic wrap |
Body bags |
Steel shackles |
Arm sleeves |
Straightjackets |
Breast bondage |
Genital bondage |
Gags |
Leather cuffs |
Infibulations |
Spreader bars |
Ceiling\Wall Hooks |
Cages |
Slings/swings |
Stocks |
Crosses |
Pillory |
Suspension, on toes |
Suspension, full |
Outdoor setting |
Indoor setting |
Public setting |
Semi-public setting |
Private setting |
1 to 3 hours |
3 to 6 hours |
Overnight duration |
Blindfolds |
Hoods |
Headphones/earplugs |
Tickling |
Feather/Furs |
Sexual teasing |
Sexual denial |
Chastity belt |
Pinching |
Hair pulling |
Nipple clamps / clips |
Clothespins |
Genital torture |
Weights |
Cock rings |
Ball spreaders |
Water torture |
Ice |
Oils, Lotions, Spices |
Vaginal fisting |
Anal fisting |
Fantasy rape |
Directed bisexuality |
Threesomes |
Groups |
Foot Kissing |
Kneeling |
Crawling |
Lead on Leash |
Dirty Words |
Verbal words |
Verbal Abuse |
Public embarrassment |
Face slapping |
Cross dressing |
Secret sex in public |
Public display |
Public sex |
Public whipping |
Infantilism |
Golden showers |
Enemas |
Innocent dress |
Slutty dress |
Prim and proper dress |
Ultra- feminine dress |
French maid |
Child/baby roles |
Slave |
Macho |
Biker |
Leathers |
Spandex |
Rubber/latex |
Mask/Hoods |
Costumes |
Lingerie |
Garters/stockings |
Corsets/cinches |
Boots |
High Heels |
Tattooing |
Body Piercing |
Branding |
Maid service |
Shaving |
Humiliation |
Foot Worship |
Exhibitionism |
Voyeurism |
T. Listed below are 6 parts of the body and 3 categories. Using the following letter codes, rate each as what is acceptable to you:
N=Never L=Light ?=Not Sure
T=Thuddy M=Medium
S=Stingy H=Heavy
BODY PART |
BONDAGE |
CORPORAL |
TORTURE |
Back/Shoulders |
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Bottom/Thighs |
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Breast/Chest |
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Genitals |
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Feet/Ankles |
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Wrist |
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