Scene Questionnaire

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 = Do not ever ask me to do this, or hard limit. 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 Y/N/T # Activity Belts Bruises Cane (leather) Cane (plastic) Cat (braided) Cat (no knots) Crop Flogger Leather Paddle Paddle Spanking Whip Wooden Hair Brush Wooden Paddle

ROLE PLAY Y/N/T # Activity Act as objects (cars, furniture, etc) Arrested Baby Burglar Attack Call Girl Cowgirl Kidnap Scene Little girl Maid Medical Scene Nun Pet Roles Pony Girl Rape Scene (multiple) (Negotiated) Rape Scene (one) (Negotiated) Secretary Student Teenager Torture Victim

HUMILIATION Y/N/T # Activity Act as objects (furniture, etc) Age Play Bathroom use control Bathroom use in front of others Blindfolds Boot worship Chauffeuring Crawl on 4's Cross Dressing Curse words (Whore, Slut, etc) Curtsy in public Dom chooses cloths Dom chooses food Enema Eye contact restrictions Foot worship Forced Cross dressing Forced dressing Forced exercising Forced masturbation Forced nudity Forced prostitution (pretend) Forced slave auction Forced to be a slave Forced to wear a leash Forced to wear see thru clothes Golden shower Harem--serving w/other(s) Hood (Full coverage) Kneeling Maid services Mask (Zorro type) Pet (forced sex w/pet) Pet roles (act like a dog, cat, etc) Scat Play Scolding Serve as ashtray Serve as toilet Serve as waitress Serve others (supervised) Serve others (unsupervised) Shave body hair Shave head Shave pubic hair Slap face Spanking (public) Speech restriction Spitting in face Stand in corner Suck pacifier Swallow urine Take Pictures Take Video Verbal Abuse Wear Collar everywhere Wear Diapers Write on Body (slut, sissy, worthless, etc.)

BONDAGE Y/N/T # Activity Arm Sleeves Blindfolds Breasts Cage Chain Chastity Belts Gag Genital Harness Hoods (Full coverage…) Immobilization (long time) Immobilization (short time) Inside a closet Inside a coffin Leather cuffs Leather restraints Leg Sleeves Mask (Zorro type) Mind Mortuary bag Mouth bits Nipple Clamps Rack Rope Saran wrapping (Body wrap) Scarves Shackles Sleeping bag Sling Spread bar Steel cuffs Steel restraints Stock Straight jacket Suspension (horizontal) Suspension (regular) Suspension (up-side down) Tied to a cross (St. Andrews Cross) Wheel of misfortune Wrestling

EDGE/MIND PLAY Y/N/T # Activity Abrasion Asphyxia Biting Branding Choking Cloth Pins Co-Topping (Two tops at once) Cutting Electric (erotic muscle stimulant unit) Electric (violet wand) Face slapping Fire and Ice (same time) Flesh Hooks Gang Rape scenes (Negotiated) Genital (cloth pins) Genital (pins/needles) Genital (rope) Genital (vise) Genital (weights) Genital whipping Gun Play Hair Pulling Hot wax Ice Medical scenes Needles Piercing Pinching Slap Face Sleep deprivation Tattoo TENS units Tickling Tit (cloth pins) Tit (pins/needles) Tit (rope) Tit (vise) Tit (weights) Torture rack Water torture

SEXUAL D/S Y/N/T # Activity Anal (vibrator/dildo) Anal beads Anal fisting Anal intercourse Anal plugs (large) Anal plugs (small) Ben wa balls Bi-sexuality Chastity Belt Cock Worship Forced bi-sexuality Hand jobs (giving) Hand jobs (receiving) Masturbation Oral sex (giving) Oral sex (receiving) Control Orgasm Denial Orgy (more then 3) Phone sex (forced with others) Phone sex (voluntary) Sexual denial (long term) Sexual denial (short term) Sexual Double Penetration Swallow semen Swapping Threesomes (FMF - Consensual) Threesomes (MFM - Consensual) Vaginal - Anal intercourse (same time) Vaginal fisting Vaginal sex Vaginal Toys Voyeurism (being watched) Voyeurism (watching other play)

FETISH WEAR Y/N/T # Activity Child/Baby Corsets French maid High Heels Leather Lingerie PVC Rubber Slutty Spandex Uniforms Victorian

WRITTEN INFORMATION:

1 Q. Do you have any hard other than items you listed as zero above? A.

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

3 Q. At this stage, what do you feel are your absolute limits: A.

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

5 Q. Why and when did you get into the scene: A.

6 Q. What do you seek from in this scene? A.

7 Q. What do you offer to the scene? A.

8 Q. Do you understand affirmative ? (Y / N) Do you agree to participate in a scene using affirmative consent? A.