My legal name is:

The name I go by during play is:

My phone number is:

My email address is:

Verify your email address -- please type carefully!

I heard about Miss Alice from:

I am located in:

How long of a session are you looking for?

When would you like to schedule a session (date/time)

I am mainly into:
D/s
Sadism
Masochism
Bondage
Fetish
Power Exchange

Visible bruises/cuts/marks must be avoided:
Yes
No, it doesn't matter if I am marked or not.
No, I want to have marks.

Have you taken any medications, including Aspirin within the last 4 - 6 hours. Please include any prescription medication you are on. 

No hit zone, if any:

Phobias or any relevant psychological issues:

Anything else important you would like to note:

Have you done this before?
I have seen a pro-Domme.
I have played a little privately.
I have never done this, ever.

I want aftercare.

Yes No

I like to talk after a scene.
Yes No

I want extensive verbal communication during a scene.
Yes No

I want music during the scene.
Yes No

Musical preferences:

Any specific types of people that turn you on?
Soldiers, marines, paratroopers
Sailors, coast guard, merchant marine
Airmen, pilots
Policewomen, security people
Truck drivers
Firemen
Executioners
Nurses, doctors
Prostitutes, tramps
Cruel/abusive women
Cowgirl
Surfers, life guards
Biker chicks
Warrior/Wrestler
Royalty, nobility
Business people, managers, "the boss."
Divas
Teachers
Daddy
Mommy

Others, please specify:

Which of the following scenes would turn you on?
Having a romantic dinner by candlelight
I am spanked because I have been a naughty boy or girl
I am in the woods and suddenly an attacker comes from behind and grabs me
A stranger walks into my bedroom and finds me playing with myself
I am are sold on a slave market
I am a foot slave, forced to care for my Mistress' feet
I am a piece for furniture, only useful as a tabletop, etc
I am forced to behave as a gender I am not
I am a dirty slut and must be punished
I am used as a slave in public
I am used as a slave in private
I am ordered to please others
I am a little schoolgirl or schoolboy
I am sitting/kneeling at my Mistress' feet
I am are tied and teased
I am grabbed by the hair and dragged into the bedroom
I am used as a dog, pony or pet
I am verbally humiliated
I am tied, gagged and blindfolded and left alone
I am tied, gagged, blindfolded and thoroughly whipped
My physical limits are tested and stretched
My mental limits are tested and stretched
I am a total slave every day of the week

Others, please specify:

Is there any particular clothing or fabric that turns you on?
Leather
Rubber, latex
Patent leather, PVC
Sexy lingerie
Uniforms
Denim
High Heels
Boots
Wet suits
Servants uniform
Masks
Dirty socks or shoes
Worn panties
Crossdressing

Others, please specify:

Do any of the following environments or scenery turn you on?

Your bedroom
A dungeon, castle
Churches and abbeys
Farms and stables
Barracks
Abandoned construction sites
Back alleys
The red light district
A school or a classroom
BDSM-clubs
Estates/Manor
Junkyards and car dumps
Woods and forests
Medieval scenery
Nudist beaches
Parking spaces
Truck stops
The bath room
Hospital, dentist
Interrogation room
The shrink's couch
Boot camp
Jail, police station

Others, please specify:

I enjoy the following psychological play:
The dominant talks, the submissive is silent or speaks only when spoken to
Dialogue in normal language
Dialogue in adapted language (Strict slave protocol)
Obey rules or else
Reasonable rules
Unreasonable rules
It is OK for the Mistress to lose her temper
Swearing and filthy talk
Military/jail type commands
Strict training
Obvious and explicit role play
Subtle role play
I like to be persuaded, rather than commanded
Make me feel guilty
Make me feel cheap
Make me feel used
Make me feel owned
Make me feel useless
Make me feel frightened
Objectify me
The dominant must have compassion
The dominant must have no compassion at all
The dominant must only have compassion after the scene

Others, please specify:

Sex and sexuality
I need to be sexually aroused when in scene
I need to be sexually aroused before I enter into a scene
An orgasm turns me off
An orgasm must only be allowed as a reward
An orgasm is the best way to end the scene
Orgasms are not important, but nice
Orgasms are not important at all
I want to beg for an orgasm first
I want my sexual abilities to be stretched
I desire strap on play as a form of release
I am not comfortable with strap-on play or insertion of any kind

Others, please specify:

I love the following attributes
Ropes
Leather cuffs and belts
Steel cuffs and chains
Ball and chain
Blindfold
Gags
Masks
Nipple clamps and clothespins
Whips
Riding crops
Canes
Silk to be tied with
Sex toys (vibrators, butt plugs)
Needles and pins
Cross, rack
Bondage table
Cage
Sling
Body bag

Others, please specify:

The following scenes appeal to me:
Being tied up, caressed and loved
Being in a public place and dominated in a subtle way
Being taken out with collar and leash
Being locked up and left alone
Being tied up in a comfortable position
Being tied up in discomfort
Being tied up and (in a sexual way) exposed
Being tied up and tickled
Being tied up and teased
Being tied up and whipped, flogged or caned
Mild CBT
Extreme CBT
Not being tied up, but verbally commanded into certain positions and having to maintain these
Caned, flogged or whipped without being tied or cuffed
Being spanked in the traditional way
Rough sex/being "raped"
Used as a servant
Being tied and tortured
Being tortured without being tied or cuffed
Being used by more than one dominant
Playing in combination with other slaves

Others, please specify:

Safe words and signals
The dominant should establish one or more safe words
When I cry, the scene should stop
I should be able to communicate in plain language
The dominant should be able to read my body language
I want to be tested until I use a safe word or signal
All activity should stop immediately when I use a safe word or signal
I do not want to use any safe word at all and my signals should be ignored completely
When I use a safe word or signal the dominant should establish if the scene can continue
A scene should go on up to the point where I use a safe word or signal
The use of safe words and signals should be avoided as much as possible

Others, please specify:

To me erotic power exchange is:
Something I like incidentally, just as a kick
Something I like, but not too often
Something I want as much as possible
A lifestyle that I consider important and want to practice as much as possible
A lifestyle that should be present at all times
My way of life
The most important thing I can think of
Something I want exercised at all times and no matter what the consequences are.

Others, please specify:

List any absolute turn offs