Please don't see this form as your opportunity to make specific requests. The purpose of this form is to assist me in deciding who you are, what BDSM or Fetish Play means to you, what your interests are and whether or not we are suited. I am not a mind reader and I see clients as individuals with different needs and desires. I specialise in bespoke sessions of quality and originality. Give me the ingredients, but let me bake the cake.
To reiterate: this is an application form, not an order form.
You may ignore sections of the form that are not relevant to you, but please ensure that that the areas that are relevant are fully completed.
I am receiving incomplete applications with incorrect email addresses. Please take the time to complete this form fully and properly. Bearing in mind that I am likely to be holding your balls in my hands some of you are remarkably vague.
The last section 'Supporting Information' is compulsory. If it isn't completed I will hit the delete key.
Name
Age
Email address Please check carefully
Mobile telephone number (don't worry, I won't call you. If you don't have a mobile you aren't eligible to see me)
How did you reach this application form? Via:
www.ladyanna.co.uk www.medicalmistress.co.uk www.fetish-clinic.co.uk Level of experience
How many Mistresses have you already seen?
How often do you session?
How important is it for you for the Mistress to be dressed in fetish clothing?
Do you have any clothing fetishes that you would like me to consider wearing, subject to my discretion?
No Yes
Please give further information regarding fabric ie stockings, leather, rubber: Please bear in mind that I cannot and will not guarantee to fulfil your request. I won't, for example, wear rubber and corsets on a very hot day. Nor will I wear just a basque and stockings, I don't wear lingerie: I am a Dominatrix, not an underwear model. Nor am I a clothes horse for your fetish.
Be honest about your health. I have enough skeletons in my closet, and bodies in my garden, as it is.
Please tick all the conditions that may be relevant to the activities I normally enjoy and add any details to the comments box below. Allergies (latex, creams, shellfish etc, please specify below) Asthma/other breathing problems Back pain Blood pressure (high or low, please specify below) Cardiac disease Claustrophobia Diabetes Epilepsy or Seizures (the Nova Pro 100 can induce seizures) Joint pain Laser eye surgery (important if interested in extreme breath play ie garotting) Pacemaker Skin conditions Stroke Surgery scars Viagra (or similar in the last 24 hours) Anything else you think I should know about, even temporary stuff ie athletes foot.
Comments:
Note: If you take poppers and Viagra (or similar) your blood pressure can drop so dangerously low that you could fall into a coma. If that doesn't kill you I bloody well will! Not on MY watch mister.
In general, can you be marked?
Please specify:
What scenario are you interested in? (please tick all that apply) Medical clinic Operating theatre Dental clinic Rubber clinic
As authentic as possible. Fetish! Don't know
Additional comments:
What do you consider yourself to be? (please tick all that apply) Submissive Masochist Patient Don't know
What is your motivation? What do you want to get from the session? (please tick all those that apply)
I want to suffer for the Mistress/Nurse My pleasure comes from providing pleasure for the Mistress/Nurse I like certain activities to be done to me, for me, the way I like them done. I want us to play as an equal partnership I don't know yet
If I am seeing you for the first time there will be the opportunity to discuss risks, limits, concerns and experience before the session. This time will not be considered part of the session so please allow extra time (approx 30mins in some cases).
How important is it for you to experience an orgasm during session? Please be aware that some session content will mean you will be incapable anyway.
Vital. It's the whole point of the session isn't it? Prefer. But only if I deserve it. Prefer. Depending on session content. Not the be and end all. Sessions are more cerebral than genital. Not necessary at all. I'm usually too wiped out. I'd rather have a hug. None of the above thanks, see comments below
Please take some time to describe what you consider Female Domination to be. This information will help me to try and ascertain whether or not we will gel during the session. Good rapport makes for an excellent session that will give both of us a huge buzz that should last for many days. A clash of unmatched expectations can make for a miserable time that will leave us both depleted of energy, but not rejuvenated with the feel good factor that should be a natural occurrence in a successful scene.
Please tick all that apply. Don't feel restricted by the scenarios. This is just to help you find particular activities. All scenarios are interchangeable and all activities can be mixed and matched.
Use this section to give me an idea of what you are interested in and what your experiences are. I have some very heavy bondage that won't suit everyone.
Medical bondage Rubber bondage Leather bondage Additional comments:
I like to cross dress during session
Knickers Stockings As part of a humiliation scenario
Additional comments
Please bear in mind that I am not a fan of full dressing or matching corsets and underwear. It does nothing for me and it hinders what I can do to you. Whatever you wear you are still required to shower prior to session.
Anal slut training Toilet slave (currently watersports only)
I'm really into degradation. Really into it.
I only film with clients who have already seen me and proved that they are sane and trustworthy.
Breath play Chemicals * Electrics Enemas Internal examinations Needles Poppers Plastic pants Sensation play Shaving (of genitals) Suturing (nipples, foreskin, male pussy) Scrotal saline inflation Urethral sounds Urethral dipsticks Violet Wand Watersports (forced, willing, from; source or glass, please specify below) Nurse uniform (Duty Nurse: Sister Anna List)
Spitting Face slapping Nettle Play
This section is compulsory to sort the genuine enquiries from the bored 'late night form tickers'. It gives you the opportunity to tell me more about yourself in your own words and why out of all the Mistresses in the area you particularly wish to see me. Prove to me that you have read my site and are serious about your application.
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