Scene Questionnaire between:______and______The following is a list of activities in the BDSM scene. It can be used by both the dominant (male or female) and the Submissive (female) to interview each other, and see what level both are at. It is also used to find commonality.

Place a check next to each box which you can relate to the most. If confused, go to the next one, and come back when finished with the rest. Answer each question honestly.

Where it says "Yes/No/Try" = means whether you've experienced that type of activity before. Put "Y" for yes or "N" for no and a “T” to try something new.

Rating scale for checklist: 0 = Don't ever ask me to do this. 1 = I don't want to do this activity, but wouldn't object if it was asked of me. 2 = I'm willing to do this activity, but it has no real appeal for me. 3 = I usually like doing this activity, at least on an occasional basis. 4 = I love doing this activity, and would like to experience it on a regular basis. 5 = I love this activity it makes me "hot", and would like it as often as possible.

Note1. Some of these may fall under a few categories (example: Blindfolds can be Humiliation & mental ) Note2. Some of these could be used for health reasons too (example forced exercising)

CORPORAL PUNISHMENT ROLE PLAY Continued Y/N/T # Activity __ [ ] Maid __ [ ] Belts __ [ ] Medical Scene __ [ ] Bruises __ [ ] Nun __ [ ] Cane (leather) __ [ ] Rape Scene (one) (Negotiated) __ [ ] Cane (plastic) __ [ ] Rape Scene (multiple) (Negotiated) __ [ ] Cat (braided) __ [ ] Pet Roles __ [ ] Cat (no knots) __ [ ] Pony Girl __ [ ] Crop __ [ ] Secretary __ [ ] Leather Paddle __ [ ] Student __ [ ] Paddle __ [ ] Teenager __ [ ] Spanking __ [ ] Torture Victim __ [ ] Whip __ [ ] Wooden Hair Brush HUMILIATION __ [ ] Wooden Paddle Y/N/T # Activity __ [ ] Act as objects (furniture, etc) ROLE PLAY __ [ ] Age Play Y/N/T # Activity __ [ ] Bathroom use control __ [ ] Act as objects (cars, furniture, etc) __ [ ] Bathroom use in front of others __ [ ] Arrested __ [ ] Blindfolds __ [ ] Baby __ [ ] Boot worship __ [ ] Burglar Attack __ [ ] Chauffeuring __ [ ] Call Girl __ [ ] Crawl on 4's __ [ ] Cowgirl __ [ ] Cross Dressing __ [ ] __ [ ] Curse words (Whore, Slut, etc) __ [ ] Kidnap Scene __ [ ] Curtsy in public __ [ ] Little girl __ [ ] Dom chooses food

Scene Questionnaire between:______and______HUMILIATION Continued BONDAGE __ [ ] Dom chooses cloths Y/N/T # Activity __ [ ] Enema __ [ ] Arm Sleeves __ [ ] Eye contact restrictions __ [ ] Blindfolds __ [ ] Foot worship __ [ ] Breasts __ [ ] Forced Cross dressing __ [ ] Gag __ [ ] Forced dressing __ [ ] Cage __ [ ] Forced exercising __ [ ] Chain __ [ ] Forced nudity __ [ ] Chastity Belts __ [ ] Forced masturbation __ [ ] Genital __ [ ] Forced prostitution (pretend) __ [ ] Harness __ [ ] Forced slave auction __ [ ] Hoods (Full coverage…) __ [ ] Forced to be a slave __ [ ] Immobilization (short time) __ [ ] Forced to wear a leash __ [ ] Immobilization (long time) __ [ ] Forced to wear see thru clothes __ [ ] Inside a closet __ [ ] Golden shower __ [ ] Inside a coffin __ [ ] Harem--serving w/other(s) __ [ ] Wheel of misfortune __ [ ] Hood (Full coverage) __ [ ] Leather cuffs __ [ ] Kneeling __ [ ] Leather restraints __ [ ] Maid services __ [ ] Leg Sleeves __ [ ] Mask (Zorro type) __ [ ] Mask (Zorro type) __ [ ] Pet roles (act like a dog, cat, etc) __ [ ] Mind __ [ ] Pet (forced sex w/pet) __ [ ] Mortuary bag __ [ ] Scat Play __ [ ] Mouth bits __ [ ] Scolding __ [ ] Nipple Clamps __ [ ] Spitting in face __ [ ] Rack __ [ ] Serve as ashtray __ [ ] Rope __ [ ] Serve as toilet __ [ ] Plastic wrapping (Body wrap) __ [ ] Serve as waitress __ [ ] Scarves __ [ ] Serve others (supervised) __ [ ] Shackles __ [ ] Serve others (unsupervised) __ [ ] Sleeping bag __ [ ] Shave head __ [ ] Sling __ [ ] Shave body hair __ [ ] __ [ ] Shave pubic hair __ [ ] Steel cuffs __ [ ] Slap face __ [ ] Steel restraints __ [ ] Spanking (public) __ [ ] Stock __ [ ] Speech restriction __ [ ] Straight jacket __ [ ] Stand in corner __ [ ] Suspension (by wrist) __ [ ] Suck pacifier __ [ ] Suspension (up-side down) __ [ ] Swallow urine __ [ ] Suspension (horizontal) __ [ ] Take Pictures __ [ ] Tied to a cross (St. Andrews Cross) __ [ ] Take Video __ [ ] Wrestling __ [ ] Verbal Abuse __ [ ] Wear Collar everywhere __ [ ] Wear Diapers __ [ ] Write on Body (slut, sissy, worthless, etc.) Scene Questionnaire between:______and______EDGE/MIND PLAY SEXUAL D/S Y/N/T # Activity Y/N/T # Activity __ [ ] Abrasion __ [ ] Anal intercourse __ [ ] Asphyxia __ [ ] Anal beads __ [ ] Biting __ [ ] Anal plugs (small) __ [ ] Branding __ [ ] Anal plugs (large) __ [ ] Choking __ [ ] Anal fisting __ [ ] Cloth Pins __ [ ] Anal (vibrator/dildo) __ [ ] Co-Topping (Two tops at once) __ [ ] Ben wa balls __ [ ] Cutting __ [ ] Bi-sexuality __ [ ] Electric (violet wand) __ [ ] Chastity Belt __ [ ] Electric (erotic muscle stimulant unit) __ [ ] Cock Worship __ [ ] Face slapping __ [ ] Forced bi-sexuality __ [ ] Flesh Hooks __ [ ] Hand jobs (giving) __ [ ] Gang Rape scenes (Negotiated) __ [ ] Hand jobs (receiving) __ [ ] Genital (weights) __ [ ] Masturbation __ [ ] Genital (cloth pins) __ [ ] Orgy (more then 3) __ [ ] Genital (pins/needles) __ [ ] Oral sex (giving) __ [ ] Genital (rope) __ [ ] Oral sex (receiving) __ [ ] Genital (vise) __ [ ] Control __ [ ] Genital whipping __ [ ] Orgasm Denial __ [ ] Gun Play __ [ ] Phone sex (voluntary) __ [ ] Hair Pulling __ [ ] Phone sex (forced with others) __ [ ] Hot wax __ [ ] Sexual denial (short term) __ [ ] Ice __ [ ] Sexual denial (long term) __ [ ] Fire and Ice (same time) __ [ ] Sexual Double Penetration __ [ ] __ [ ] Swallow semen __ [ ] Medical scenes __ [ ] Swapping __ [ ] Needles __ [ ] Threesomes (Consensual) __ [ ] Piercing __ [ ] Vaginal sex __ [ ] Pinching __ [ ] Vaginal fisting __ [ ] __ [ ] Vaginal Toys __ [ ] Slap Face __ [ ] Vaginal - Anal intercourse (same time) __ [ ] Sleep deprivation __ [ ] Voyeurism (being watched) __ [ ] Tattoo __ [ ] Voyeurism (watching other play) __ [ ] TENS units __ [ ] Tickling __ [ ] Tit (weights) __ [ ] Tit (cloth pins) __ [ ] Tit (pins/needles) __ [ ] Tit (rope) __ [ ] Tit (vise) __ [ ] Torture rack __ [ ] Water torture

Scene Questionnaire between:______and______FETISH WEAR Y/N/T # Activity __ [ ] Corsets __ [ ] French maid __ [ ] Child/Baby __ [ ] High Heels __ [ ] Leather __ [ ] Lingerie __ [ ] PVC __ [ ] Rubber __ [ ] Slutty __ [ ] Spandex __ [ ] Uniforms __ [ ] Victorian

WRITTEN INFORMATION:

1. Write down any other role play activities not mentioned above, which you may be interested to try:

2. At this stage, what do you feel are your absolute :

3. Do you have any medical conditions and emotional concerns that I should know about? Y/N (if yes explain) :

4. Why and when did you get into the scene:

5. What do you seek from a Dominant/Top:

6. What do you offer as a submissive (emotionally and spiritually):