Are there any specific types of people that turn you on?
[ ] Soldiers, marines, paratroopers
[ ] Sailors, coast guard, merchant marine
[ ] Airmen, pilots
[ ] Policemen, security people
[ ] Truck drivers
[ ] Firemen
[ ] Executioners
[x] Nurses, doctors
[ ] Prostitutes, tramps
[ ] Hunters
[ ] Wrestlers
[ ] Surfers, life guards
[ ] Motorcycle people, Hells Angels
[x] Cowboys, farm boys
[ ] Gentlemen, nobility
[ ] Business people, yuppies, managers
[ ] Servants
[x] Teachers
[ ] Daddy, uncle
Others, please specify: ___________________________________

Which of the following scenes would turn you on?
[ ] Having a romantic dinner by candlelight
[ ] I am spanked because I have been a naughty girl
[ ] I am in the woods and suddenly this man comes from behind and grabs me
[x] A stranger walks into my bedroom and finds me playing with myself
[x] My partner and I are making love in a public place
[ ] I am are sold on a slave market
[ ] I am used as a slave in public
[x] I am used as a slave in private
[x] I am ordered to please others
[ ] I am a little schoolgirl
[x] I am sitting/kneeling at my Master's feet
[x] I am are tied and teased
[ ] I am grabbed by the hair and dragged into the bedroom
[ ] I am used as a dog, pony or pet
[ ] I am verbally humiliated
[ ] I am tied, gagged and blindfolded and left alone
[x] I am tied, gagged, blindfolded and thoroughly whipped
[x] My physical limits are tested and stretched
[x] My mental limits are tested and stretched
[x] I have to sign a contract
[x] I am a total slave every day of the week
Others, please specify: ___________________________________

Is there any particular clothing or fabric that turns you on?
[x] Leather
[ ] Rubber, latex
[ ] Patent leather, PVC
[x] Sexy lingerie
[ ] Uniforms
[x] Denim
[ ] High Heels
[ ] Boots
[ ] Wet suits
[ ] Servants uniform
[ ] Masks
Others, please specify: ___________________________________

Do any of the following environments or scenery turn you on?
[ ] Your bedroom
[x] A dungeon, castle
[x] Churches and abbeys
[x] Farms and stables
[ ] Barracks
[ ] Abandoned construction sites
[ ] Back alleys
[ ] The red light district
[ ] A school or a classroom
[ ] BDSM-clubs
[ ] Estates
[ ] Junkyards and car dumps
[x] Woods and forests
[ ] Medieval scenery
[ ] Nudist beaches
[ ] Parking spaces
[ ] Truck stops
[ ] The bath room
[ ] Hospital, dentist
[ ] Interrogation room
[ ] The shrink's couch
[ ] Boot camp
[ ] Jail, police station
Others, please specify: ___________________________________

I enjoy the following psychodrama(s):
[ ] The dominant talks, the submissive is silent or speaks only when spoken to
[ ] Dialogue in normal language
[ ] Dialogue in adapted language ("Master" and "slave")
[x] Obey rules or else
[x] Reasonable rules
[ ] Unreasonable rules
[ ] It is OK for the dominant to loose his temper
[x] Swearing and filthy talk
[ ] Military/jail type commands
[ ] Strict training
[ ] Obvious and explicit role play
[ ] Subtle role play
[ ] I like to be persuaded, rather than commanded
[ ] Make me feel guilty
[ ] Make me feel cheap
[ ] Make me feel used
[ ] Make me feel owned
[ ] Make me feel useless
[ ] Objectify me
[ ] The dominant must have compassion
[ ] The dominant must have no compassion at all
[ ] The dominant must only have compassion after the scene
Others, please specify: ___________________________________

Sex and sexuality
[x] I need to be sexually aroused when in scene
[x] I need to be sexually aroused before I enter into a scene
[x] I like as many orgasms as I can get
[ ] An orgasm turns me off
[ ] An orgasm must only be allowed as a reward
[ ] An orgasm is a must to end the scene
[ ] Orgasms are not important, but nice
[ ] Orgasms are not important at all
[x] I want to beg for an orgasm first
[x] I want my sexual abilities to be stretched
[ ] I want/need sex during a scene
[ ] I want no sex during a scene
[ ] Sex should be used to relieve the tension
Others, please specify: ___________________________________

I love the following attributes
[ ] Ropes
[x] Leather cuffs and belts
[x] Steel cuffs and chains
[ ] Ball and chain
[x] Blindfold
[ ] Gags
[ ] Masks
[ ] Nipple clamps and clothespins
[x] Whips
[x] Riding crops
[x] Canes
[x] Silk to be tied with
[x] Sex toys (vibrators, butt plugs)
[ ] Needles and pins
[ ] Cross, rack
[ ] Bondage table
[ ] Cage
[ ] Sling
[ ] Body bag
Others, please specify: ___________________________________

The following scenes appeal to me:
[x] Being tied up, caressed and loved
[x] Being in a public place and dominated in a subtle way
[ ] Being taken out with collar and leash
[ ] Being locked up and left alone
[ ] Being tied up in a comfortable position
[x] Being tied up in discomfort
[x] Being tied up and (in a sexual way) exposed
[ ] Being tied up and tickled
[x] Being tied up and (sexually) teased
[x] Being tied up and whipped, flogged or caned
[ ] Not being tied up, but verbally commanded into certain positions and having to maintain these
[ ] Caned, flogged or whipped without being tied or cuffed
[ ] Being spanked in the traditional way
[ ] Rough sex/being "raped"
[x] Used as a servant
[x] Being tied and tortured
[ ] Being tortured without being tied or cuffed
[ ] Being used by more than one dominant
[x] Playing in combination with other couples
Others, please specify: ___________________________________

Safe words and signals
[ ] The dominant should establish one or more safe words
[ ] When I cry, the scene should stop
[ ] I should be able to communicate in plain language
[x] The dominant should be able to read my body language
[ ] I want to be tested when I use a safe word or signal
[ ] All activity should stop immediately when I use a safe word or signal
[x] I do not want to use any safe word at all and my signals should be ignored completely
[ ] When I use a safe word or signal the dominant should establish if the scene can continue
[ ] A scene should go on up to the point where I use a safe word or signal
[ ] The use of safe words and signals should be avoided as much as possible
Others, please specify: ___________________________________

To me erotic power exchange is:
[ ] Something I like incidentally, just as a kick
[ ] Something I like, but not too often
[ ] Something I want as much as possible
[ ] A lifestyle that I consider important and want to practice as much as possible
[ ] A lifestyle that should be present at all times
[ ] My way of life
[ ] The most important thing I can think of
[ ] Something I want exercised at all times and no matter what the consequences are.
Others, please specify:Something I imagine I'd crave were I with someone that would embrace it.

__________________
Though I am different from you,
We were born involved in one another.

For it was not into my ear you whispered, but into my heart. It was not my lips you kissed, but my soul.

Complete surrender should not just come at moments in which one faces overwhelming odds, but in the calm when it seems one is personally in complete control of one's life.