Name: This form is the beginning of negotiations. You still need to talk!

There are no right or wrong answers. If you answer honestly, you are more likely to have a good
Playing with: time. You may not get everything on your list, but honesty plus conversation with your partner
should help you find common ground.
Remember the phrase: “What do you mean by __________?”
My definition of “heavy impact” may be very different than yours!
Today, I want to be a… Don’t up-negotiate during a scene. If you didn’t talk about it before, don’t do it.
 Top  Bottom  Switch You can revoke consent at any time before or during an activity.
You cannot revoke consent after the fact. That is called regret.
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Today I want… ▪ Check things you know you want.

Bondage Sensation Play Impact Play Role Play Touching, Intimacy, Sex
 Blindfolds  Biting  Spanking  Boss / Employee  Cuddling
 Collar/Lead  Edge Play  Punching  Burglar / Victim  Dirty Talk
 Leather Cuffs  Electricity  Paddles  Doctor / Patient  Groping
 Metal Cuffs  Hair pulling  Canes  Human Furniture  Kissing
 Gags  Knives  Floggers  Kidnapper / Captive  Open Mouth Kissing
 Rope  Licking  Whips  Law Enforcer / Convict  Exhibitionism
 Box Tie / TK  Mind Fucks  Little  Hands On Genitals
 Intro
 Floor Bondage  Nipples  Non-con  Orgasms
 Light
 Suspension  Playing with Hair  Owner / Pet
 Heavy  Giving Oral Sex
 Pressure Points  Royalty / Servant
 Cross  Stingy  Receiving Oral Sex
 Scratching  Teacher / Student
 Bench  Thuddy  Condoms/Dent Dams
 Sensory Deprivation  Wealthy / Commoner
 Table  Fluid Exchange
 Sharp  Other  Other
 Cages
 Tickling
 Hoods
 Other Marks Safewords Penetration
 Decorative
 Restrictive  None  Plain Language  Fingers  Oral
 Mental  For Today  Red /Yellow/Green  Penis  Vaginal
 Other  For the Week  “Safeword”  Toys  Anal
 Longer (discuss)  Other (discuss)

I want to feel… Aftercare You should know about my: I do not want to be touched here:
 Beautiful  ~ ___ - ___ mins Partners:
 Catharsis
 Water
 Controlled Triggers:
 Electrolytes
 Degraded
 Salt
 Dominant Medical Conditions & Meds:
 Sugar
 Energetic
 Snack
 Erotic Injuries:
 Helpless  Let me be
 Masochistic  Blanket STI status:
 Overwhelmed  Cuddling
 Peaceful  Comfort Item Allergies:
 Platonic  Conversation
 Playful  Service Safe Call:
 Sadistic  Snuggly Clothes
 Serious  Socialize
 Submissive  Check in Tomorrow

Other Notes (desires, limits, other):