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Please Copy and Paste into the body of an email and return to Me for consideration;


My email addresses

Name and last initial______________________

When are you requesting an audience with your Goddess?



Physical Description_______________________________________________________

Marital Status__________

Financial Status and Employment Industry________________________________

Sexual Orientation__________________________

Medical Concerns/ Physical Limitations_________________________________________

Phobias/Abuse Issues__________________________________________

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

How often do you wish to visit with Me, Weekly? Bi-Weekly? Monthly? Bi-annually?______________________________

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)_____________________________

Do you have any other skills outside slavery that you can offer Me? How will you please your Goddess other than Her required tribute? _______________________________________________


Are you comfortable being in a session/scene/show/party, with others? Mask optional. (please choose all that apply and delete the rest)

Dominant Females /Dominant males/ Submissive Females/ Submissive males/ Photographers/ Videographers/ Vanilla Voyeurs

ACTIVITIES I AM INTERESTED IN: (please choose all that apply and delete the rest)

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 Torture: Kicking/Kneeing, Trampling, Vise, Stretching, Weights, Bondage, Manual Squeezing

4. Foot Worship: Stocking/Pantyhose, Shoe/Boot/Heel, Bare Feet
Method: Bootlicker, Toe Kisser, Masseuse, Footstool, Rug

5. Humiliation: SPH, Diapering, Cuckholding Fantasy, Sploshing, Toilet Training, F-Bi Fantasy
  Other: (please describe)____________________________________

6. Domestic Service Training: Maid, Chauffeur, Foot slave, Party Favor, Errand boy

7. Feminization: Shaving, Makeup, Crossdressing, Salon Services, Public Play, Strap-on  

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

10. Financial slave/Paypig (yes or no)___________

12. Chastity/Key-Holding: (yes or no)___________
     Duration: Long term/ Short term /Session only
     Personal Device: ___________

13. Medical Play: Electrical, Urethral Sounds, Needles, Anal Play, Physical Exam, Enema

14.  Is there a specific role-play scenario you are seeking? (Please describe) ________________________


Medical Concerns, Physical Limitations:




Viagra and other erection enhancing medications: 


It is not recommended that you take this class of medication prior to a BDSM session.  BDSM activities are exciting by nature and combined with Viagra or similar drugs, undesired side effects like shaking, dizziness and even fainting can result. 


If you do take an erectile enhancing drug prior to our session, be sure to disclose this so I can take the necessary precautions.  


Phobias, Abuse Issues: 

Eyeglasses, Contacts? 

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

           *All information will be held in the strictest of confidence by

madame elise*

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