Negotiation Long Form Do answer the questions honestly and openly, for this will help The Dominant in making the submissive's experience wonderful. 1. People Who will take part? Who will watch? Note: The session will involve only those people specify named above. Will any permanent record be made of the session (photographs, video, audiotapes? Yes No Explanation:
2. Roles Who will be dominant? Who will be submissive? Type of scene: Mistress/Slave Captive Servant/Butler/Etc Cross-dressing/gender play age play animal play other Any chance of switching roles? Yes No Explanation:
3. Place Location Who will ensure privacy?:
4. Time Begin at: Length: Beginning signal: Ending signal: Who will keep track of time?:
5. Obedience Will submissive promptly obey? Yes No Explanation May the dominant "overpower" or "force" the submissive? Yes No Explanation May the submissive verbally resist? Yes No Explanation May the submissive physically resist? Yes No Explanation May the submissive try to "turn the tables"? Yes No Explanation Does the submissive agree to wear a collar? Yes No Explanation The submissive agrees to address the dominant by the following titles::
6. Limits submissive's limits submissive's physical/emotional/SM activity limits: Any problems with the submissive's: Heart Yes No Liver Yes No Lungs Yes NO Neck/Back/Bones/Joints Yes No Kidneys Yes No Nervous System/Mental Yes No Explanation
Is the submissive wearing contact lenses? Yes No Does the submissive have implanted pace maker? Yes No Drug Metering Pumps? Yes No
Does the submissive have a history of.... Seizures Yes No Dizzy Spells Yes No Diabetes Yes No Hyperglycemia Yes No Seizures Disorders Yes No Known Brain Wave Abnormalities Yes No High Blood Pressure Yes No Fainting Yes No Asthma Yes No Heart Rhythm Oddities Yes No Explanation
Hyperventilation attacks Yes No Describe any phobias:
Any surgical implants (breast, face, etc.?) Yes No Explanation
Is the submissive taking aspirin? Yes No Is the submissive taking ibuprofen, Motrin, or other non-steroidal, anit-infammatory drugs? Yes No Is the submissive taking antihistamines? Yes No Other medications submissive is taking:
Allergic to; Bandage tape: Yes No Nonoxynol-9 Yes No Other allergies: In case of emergency notify:
Dominant's Limits Any problems with the dominant's: Heart-Yes No Liver-Yes No Lungs-Yes No Neck/Back Injuries Yes No Bones/Joints-Yes No Kidneys Yes No Nervous System/Mental-Yes No
Heart Rhythm Oddities- Yes No Seizure Disorders Yes No Implanted Pace Maker-Yes No Drug Metering Pumps-Yes No Known Brain Wave Abnormalities-Yes No
Dominant's other medical conditions:
Medications dominant is taking:
Is the dominant currently certified in First Aid and CPR-Yes No Safety gear on hand: Paramedic scissors: Yes No Fire extinguisher: Yes No First Aid Kit: Yes No Blackout lights: Yes No Flashlight: Yes No
Will play take place in an isolated area such as a farmhouse or other location?: Yes No If yes, what precautions will ensure the submissive's safety if the dominate becomes unconscious?
7. Sex Are you Male? Yes No Are you Female? Yes No Are you a TS?
Does any participant believe they might have a trichomonas or yeast infection Yes No Explanation:
Does any participant believe they might have herpes? Yes No Explanation:
Does any participant believe they might have any STD? Yes NO Explanation:
Does any participant believe they might have Hepatitis? Yes No Explanation:
Have participant been tested for HIV? Yes No Been tested positive? Yes No Explanation:
Check off which of the following sexual acts are acceptable: Dominant to Submissive submissive to Dominant
Masturbation " "
Fellatio " "
Cunnilingus " "
Rimming " "
Anal Fisting " "
Vaginal Fisting " "
Vaginal intercourse Yes No
Anal intercourse " "
Is swallowing of semen acceptable Yes No
Will any sex toys such as vibrators, dildoes, butt plugs, ben wa balls, etc be used? Yes No Describe:
Which of the above activities will involve birth control pills, diaphragms, spermicidal suppositories, lubricants containing nonoxynol-9, or contraceptive foam/suppositoried/gel?
Which of the above activities will involve condoms, gloves, dental damns, and/or other barriers?
8. Intoxicants The dominant can use (only) the following intoxicants during the session: Acceptable quantity:
The submissive can use (Only) the following intoxicants during the session: Acceptable quantity:
9. Bondage The submissive agrees to allow (only) the following types of bondage: Hands in front Yes No Hands behind Yes No Ankles Yes No Knees Yes No Elbows Yes No Wrists to ankles(hog-tie) Yes No Spreader bars: Yes No Tied to Chair Yes No Tied to bed Yes no Use of blindfold Yes No Use of gag Yes No Use of hood yes no Use of rope Yes No Use of handcuffs/metal restraints Yes No Use of tape Yes No Use of leather cuffs Yes No Suspension Yes No Acceptable degree of immobility/helplessness: Limited Moderate Extreme Explanation
10. Pain submissive's general attitude about receiving pain: Likes Accepts Neutral Dislikes Will not accept
Quantity of pain submissive wants to receive: None Small Average Large Explanation:
Dominant's general attitude about giving pain:
Quantity of pain dominants wants to give:
The following types of pain are acceptable: Spanking Yes No Paddling Yes No Whipping Yes No Caning Yes No Face slaps Yes No Biting Yes No Nipple clamps Yes No Genital clamps Yes No Clamps elsewhere Yes No Locations: Hot creams Yes No Ice Yes No Hot Wax Yes No Other types/methods of pain: Additional remarks:
11. Marks Is it acceptable to the submissive if the play leaves marks? Yes No Visible while wearing street clothes? Yes No Visible while wearing a bathing suit? Yes No Other:
Is it acceptable to the submissive if the play draws small amounts of blood? Yes No Explanation:
How easy of difficult has it been to mark the submissive in the past?
12. Erotic Humiliation The submissive agrees to accept being referred to by the following terms: The submissive agrees to the following forms of erotic humiliation: "Verbal abuse" Yes No Enemas Yes No Spitting Yes No Water Sports Yes No Scat games Yes No Other: Any prior really good or really bad experiences in these areas?
13. Safe Words Safe Words #1 and its meaning Safe word #2 and its meaning Safe word #3 and its meaning Non-verbal safe words and their meaning Will "two-squeezes" be used? Yes No
14. Opportunities/Special Skills Anything in particular either party would like to try and explore?
15. Follow-Up After the session we need a coming down period The next day we should discuss how things went A week later follow-up In case of crisis:
16. Anything Else?
Post-session notes: Dominant Best Part 1-10 scale(ten tops) Worst Part 1-10 Most memorable part 1-10 Other comments:
Submissive Best part 1-10 Worst Part 1-10 Most memorable 1-10 Other comments