This questionnaire should be filled out by a Sub and provided to their Dom/Top before playing with them.

This
will provide a quick "head-start" to identifying limits, negotiating and finding common ground for play.

There is intentionally some overlap between categories. Unless otherwise stated, the Sub is the recipient of the
activity.

For each item, you need to provide two answers:

1. First write YES or NO next to each item to indicate if you have ever DONE that activity. Mark N/A if it
does not apply to your gender.
2. Indicate for each item how you FEEL about that activity by rating it on a scale of NO or 0 to 5.
 NO - you will NOT do that item under any circumstances (a hard limit).
 0 (zero) - indicates you have utterly no desire to do that activity and don't like doing it (in fact, may loath
it) and would ordinarily object to doing it, but you would be willing to do it to please the Dominant if it
they really wanted it. (sometimes called a "soft limit").
 1 - you don't want to do or like to do this activity, but wouldn't object if it was asked of you.
 2 - you are willing to do this activity, but it has no special appeal for you.
 3 - you usually like doing this activity, at least on an irregular/ occasional basis.
 4 - you like doing this activity, and would like to experience it on a regular basis.
 5 - the activity is a wild turn-on for you, and you would like it as often as possible.
3. Note any additional information that might be important for your Dom to know in the comments box.
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Age Play
Animal roles (Doggy)
Arm & leg sleeves
(arm binders)
Asphyxiation
Bathroom use control
Beating (soft) 4
Beating (hard)
Blindfolds 5
Being serviced (sexual) 5
Being bitten 3
Breast/chest bondage 4
Breath control 0
Bondage
Hands in Front 5
Hands Behind
Hands over head
Ankles
Knees
Elbows
Wrist-to-ankles
Wrist-to-waist
Spreader Bars 5
Tied to a Chair 4
Tied to a Bed 5
Using Rope 3
Using Tape 0
Metal Cuffs 4
Leather Cuffs 5
Silk ties 5
Breast whipping 3
Cages (locked inside of) 0
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Caning 3
Cells/Closets
(locked inside of)
Chastity belts 0
Choking 0
Clamps
Nipples 0
Genital 0
Other 0
Cock worship 5
Collars 3
Corsets (wearing)
Cunnilingus 5
Face slapping 4
Fantasy abandonment
Fantasy rape 4
Following orders 5
Forced dressing 5
Forced masturbation 4
Forced nudity 5
Full head hoods 0
Gags (cloth) 3
Gags (rubber) 0
Gags (tape) 0
Genital sex 5
Golden showers 0
Hairbrush spankings 1
Hair pulling 4
Hand jobs 5
Harnessing (leather)
Harnessing (rope)
Head (giving fellatio) 5
Homage with tongue 5
(non-sexual)
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Hot oils (on genitals) 0
Hot waxing 0
Ice cubes 1
Initiation rites 4
Intricate rope bondage
Interrogations 5
Kneeling 5
Leather clothing 5
Leather restraints 5
Lectures for misbehavior 4
Licking (non-sexual)
Manacles & Irons
Manicures 5
Massage (giving) 5
Massage (receiving) 4
Modeling for erotic photos
Mouth bits 5
Nipple weights 3
Oral/anal Licking (rimming) 3
Over-the-knee spanking 4
Orgasm denial
Orgasm control 4
Phone sex (serving Dom) 5
Prison scenes 0
Pussy/cock whipping 4
Riding crops 4
Rubber/latex clothing 4
Rope body harness
Scratching - getting 3
Scratching - giving: 3
Sensory deprivation
Serving
Serving as art 0
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments
Serving as ashtray
Serving as furniture 0
Serving as a maid: 0
Serving as waitress/waiter 4
Serving orally (sexual) 5
Sexual deprivation
(short term)
Sexual deprivation
(long term)
Sleep deprivation 3
Sleep sacks
Slutty clothing 5
Spanking 5
Spandex clothing
Standing in corner
Stocks
Swallowing semen 0
Teasing
Tickling
Uniforms 5
Vaginal dildo 0
Verbal humiliation
Vibrator on genitals 5
Video (recordings of you) 5
Wearing symbolic jewelry 5
Whipping 5
Wooden paddles
Wrestling 0
 Experience Willingness
Activity Yes/No No or scale 0-5 Comments