Appointment Application

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INSTRUCTIONS: Copy and paste this form into an email to Me at stellinaobscura@proton.me. Complete ALL responses and send. 

Name and last initial:
Phone Number:
(I will never call you without discussing it first)

When are you requesting My time? (My days off are Tuesday and Thursday)
Date:
Time:
Duration:

Age:

Physical Description:

Marital Status:
Sexual Orientation:  

Financial Status and Employment Industry:

Medical Concerns/ Physical Limitations:

Surgeries (Within the last 3 years):

Phobias/Abuse/Trauma Issues:

Can you be marked? If so, for how long?

Do you have any attire requests for My wardrobe? (fetish clothing, accessories, or shoes)

How long have you been involved in BDSM activities? (Professional/ Personal)

Is this your first time visiting Atlanta Dungeon?

Do you have references from other Professional Dommes? (local, national, or international)

Tell me about yourself in one brief paragraph: 

ACTIVITIES I AM INTERESTED IN: (please choose all that APPLY and delete those that DONT APPLY)

1. Bondage: Leather, Rope, Bondage tape, Saran wrap
  Bondage Level: Light, Inescapable, Extended, Mummification

2. Corporal Punishment: Flogging, Whipping, Spanking, Caning, Paddling, OTK

3. Genital Torment: Kicking/Kneeing, Trampling, Vise, Stretching, Weights, Bondage, Manual Squeezing

4. Foot Worship: Stocking/Pantyhose, Shoe/Boot/Heel,
Method: Bootlicker, Boot cleaning, Footstool/human furniture, Rug

5. Humiliation: SPH, Diapering, Cuckholding Fantasy (Verbal ONLY), Sploshing, Toilet Training, F-Bi Fantasy (Verbal ONLY),
  Other (Please describe here):

6. Domestic Service Training: Maid, Foot slave, Errand boy, Wine & Charcuterie

7. Feminization: Dress up, Shaving, Makeup, Crossdressing, Public Play, Strap-on Fanstasy

8. Puppy Training: Caging, Water bowl & Dog Food Consumption, Leash Training, Verbal Command Training

10. Gentle/Sensual Femdom: Motherly Guidance & Discipline, sensation play, Nurturing/encouraging submission training (must be paired with other interests)

11. Mindfucking/Psychological Domination (must be paired with other interests)

12. Chastity/Key-Holding. If yes, then how long?
     Duration: Long term/ Short term /Session only
     Do you own a chastity device? Describe it here:

13. Medical Play: Electrical, Urethral Sounds, Anal Play, Physical Exams

14. Roleplay interests: Teacher, Dominant Wife/Girlfriend, Girl Bully, Nurse, Massage Therapist, Mommy

15.  Describe the specific scene or role-play scenario you are seeking:

16. Where did you find Me?
 

 *All information provided is confidential.

DISCLAIMER: I do not provide illegal or sexual services. Please review the list of specialties above. No sexual acts offered. ONLY fantasy play!