BDSM Education- Original Negotiation Form

I am the creator of the original D/s (BDSM) negotiation form. I first wrote the negotiation form in the 70's and published the negotiation form back in 1982/83.

A bit of history- I created the negotiation form as a way to get those about to play with me to do some soul searching and thinking about what they were about to get into. It made it easier for me to get information about their wants, expectations, and any health issues etc. and having it all on paper made it easier than trying to remember it all when planning to play with them. It also gave them information about me. I stupidly used my negotiation form with a woman (that happened to be a publisher) for use between us for play. It appears her and her partner plagiarized my work as it ended up in their BDSM books with no credit to me. It was not theirs and to steal my work, knowledge, and effort is not okay.

I have given only a couple of web sites permission to display my copyrighted works and they have a my permission notice listed with a link to this site. Unfortunately people continue to have my work on their web site and/or in books without my consent and this continues to be an issue. Hopefully web sites and publishers will do the correct thing so my negotiation form can still be a resource for those into or wanting to explore BDSM.

So if you see my negotiation form (or part of it) on another BDSM site or the Internet without credit to me, please let us know. They are violating copyright laws.

Interested in learning more about copyrights? For your convenience here are a few links:
http://whatiscopyright.org/ http://www.templetons.com/brad/copymyths.html

My negotiation form has grown since it's first publication, over the years it has grown to include things that were not around or of concern to us back in the late 70's and early 80's. The most current version and most current layout is found in my book Top to Bottom A BDSM Perspective. I hope you find this form helpful.

I created this form originally for me, the Domme to gain insight about the sub/bottom/slave and to force the sub/bottom/slave to do some real soul searching about themselves and BDSM.
Since most feel BDSM is an exchange of power, you will find sections for both the sub/bottom/slave and the Dom/me to fill out.

>Negotiation Long Form

Not all applies to our scenes, do answer the questions honestly and openly, for this will help me in making your experience wonderful. The answers I am willing to share at this time are found under Dom/me, your answers should be under sub and all sub questions should be completed.

1.	People
	Who will take part?
	Who will watch?
	Note: Unless prior negotiation is done, the session will involve only those people specifically named above.
	Will any permanent record be made of the session?	Yes	No
	Will any photographs be taken?	Yes	No
	Will any video be taken?	Yes	No
	Will any audiotapes be made?	Yes	No
	Would you like a future session to have photos taken?	Yes	No
	Would you like a future session to have video taken?	Yes	No

	Do you currently have any involvement with law enforcement agencies? If no, you are obligated to let me know if you become involved with any law enforcement agency. e.g.: Are you a police officer in any aspect? Are you on parole?
	Dom/me	Yes	No
	sub	Yes	No
	If yes explain-

2.	Roles
	Who will be Dominant?
	Who will be submissive?
	Type of scene:	Dom/me	Dom/me	sub	sub
	Mistress/Slave	Yes	No	Yes	No
	Captor/Captive	Yes	No	Yes	No
	Servant/Butler	Yes	No	Yes	No
	Age play	Yes	No	Yes	No
	Cross-dressing/gender play	Yes	No	Yes	No
	Animal play	Yes	No	Yes	No
	Any chance of switching roles?	Yes	No	Yes	No
	Others? Explain:

3.	Place
	Location:
	Who will ensure privacy?	Dom/me	sub	Both	Others
	Will play take place in an isolated area such as a farmhouse or other location?	Yes	No	Maybe
	Will play take place at a play party/dungeon?	Yes	No	Maybe
	Will play take place outdoors?	Yes	No	Maybe
	Dom/me are you currently certified in First Aid?	Yes	No
	submissive are you currently certified in First Aid?	Yes	No
	Dom/me are you currently certified in CPR?	Yes	No
	submissive are you currently certified in CPR?	Yes	No
	First Aid kit to be on hand? If yes, who will bring it?	Yes	No
	Flash Light to be on hand? If yes, who will bring it?	Yes	No
	Blackout lights to be used? If yes, who will bring it?	Yes	No
	What precautions will be done to ensure safety for both in a medical situation?
	Example: Panic snaps so submissive can get free if dominant becomes unconscious. What other precautions will be used? List all that apply.

4.	Time
	Begin at:
	Length of time:
	Beginning Signal: (example some like to do a ritual or play collaring)
	Ending Signal:
	Who will keep track of time?

5.	Obedience
	Will submissive promptly obey?	Yes	No	Most of the time
	May the dominant "overpower" or "force" the submissive?	Yes	No	Would like to explore
	Explanation:
	Might the submissive want to verbally resist?	Yes	No	Would like to explore
	Explanation:
	Might the submissive want to physically resist?	Yes	No	Would like to explore
	Explanation:
	Does the submissive want to try to "turn the tables"?	Yes	No	Would like to explore
	Explanation:
	Does the submissive agree to wear a collar?	Yes	No
	Explanation:
	The submissive agrees to address the dominant by the following titles: (include any others)	Sir/Ma'am	Master/Mistress	My Lord/My Lady

6A.	Limits
	Submissive's limits:
	What is your current health condition?	Poor	Fair	Average	Good	Excellent

	Submissive's physical/emotional/BDSM activity limits:
	Any problem with the submissive's:			Explanations
	Heart	Yes	No
	Liver	Yes	No
	Lungs	Yes	No
	Neck/Back/Bones/Joints?	Yes	No
	Kidneys	Yes	No
	Nervous System	Yes	No
	Mental Illness	Yes	No
	FYI- Diabetes, Heart Disease and Asthma are three of the most common diseases that can have negative effect on play. I need to know what can occur and we need a plan to handle these diseases in our play.

	Have you, the submissive had a heart attack?	Yes	No
	If yes, When?
	What medications are you taking? List all medications (not just heart medication): FYI-Heart medications can alter your blood pressure and I need to know this.
	Are you wearing contact lenses?	Yes	No
	Are you wearing dentures or any other dental appliance?	Yes	No
	Do you have implants? If yes, list them all:	Yes	No
	Do you have implanted pace maker?	Yes	No
	Do you have metal implants? If yes, where?	Yes	No
	Do you have a drug metering pump? If yes, for what drugs?	Yes	No
	Do you have any artificial body parts? If yes, give list	Yes	No
	Do you have a history of:
	Seizures	Yes	No
	Dizzy Spells	Yes	No
	Diabetes	Yes	No
	Hyperglycemia	Yes	No
	Seizure disorders	Yes	No
	Known brain wave abnormalities	Yes	No
	High blood pressure	Yes	No
	Fainting	Yes	No
	Asthma	Yes	No
	Heart Rhythm oddities If yes, give explanation	Yes	No
	Do you have problems with circulation?	Yes	No
	Are you subject to leg cramps or charley horses?	Yes	No
	Do you have any foot problems?	Yes	No
	Do you have any hearing problems?	Yes	No
	Do you have an eye sight problems?	Yes	No
	Do you have any old injuries that still cause discomfort?	Yes	No
	Hyperventilation attacks?	Yes	No
	Describe any phobias:
	submissive's medical conditions:
	Have you had any surgeries? If yes, list them:	Yes	No
	Do you have any surgical implants (breast, face, etc.)? Explanation:	Yes	No
	Do you have hemorrhoids? If yes, do you feel this will have an effect on our play?	Yes	No
	Are you, the submissive taking:
	Aspirin?	Yes	No
	Non-steroidal, anti-inflammatory drugs?	Yes	No
	Ibuprofen, Motrin, Naprosen, Aleve, Vioxx, Celebrex or other? These can cause a person to bruise quicker/easier with less impact/force then in "normal" play.	Yes	No	Please list them:
	Are you taking anti-histamines? Examples; Benadryl, Hismanal, Atarax, Actifed, and Seldane. These can cause blood pressure changes as well as changes in equilibrium.	Yes	No	Please list them:
	List any other medication you, the submissive are taking:
	Do you have any known allergies?	Yes	No
	Bandage tape?	Yes	No
	Nonoxynol-9	Yes	No
	Latex	Yes	No
	Food allergies? If yes, list them:	Yes	No
	Drug allergies? If yes, list them:	Yes	No
	Any allergy to any metals? If yes, please list the metals:	Yes	No
	Any allergy to rubbing/isopropyl alcohol?	Yes	No
	Allergy to semen?	Yes	No
	Allergy to any lubes? If yes, list them:	Yes	No
	Allergy to any chemicals?	Yes	No
	Allergy to any animal?	Yes	No
	List any other allergies:
	List any other medical conditions:

	In case of emergency notify:	Phone#:
	Name and phone number of the medical general practitioner you would like called in an emergency visit to the hospital.
	What information is to be given in emergency?
	Any possibility you are pregnant?	Yes	No


6B.	Limits
	Dominant's limits.
	What is your current health condition?	Poor	Fair	Average	Good	Excellent
	Any problems with your:
	Heart	Yes	No
	Liver	Yes	No
	Lungs	Yes	No
	Neck/Back/Bones/Joints?	Yes	No
	Kidneys	Yes	No
	Nervous System	Yes	No
	Mental Illness	Yes	No
	Have you, the dominant had a heart attack? If yes, when?	Yes	No

	What medications are you taking? List all medications (not just heart medications): FYI-Heart medications can alter your blood pressure and the sub needs to know this in case something happens.
	Are you wearing contact lenses?	Yes	No
	Are you wearing dentures or any other dental appliance?	Yes	No
	Do you have implants? If yes, list them all:	Yes	No
	Do you have implanted pace maker?	Yes	No
	Do you have metal implants? If yes, where?	Yes	No
	Do you have a drug metering pump? If yes, for what drugs?	Yes	No
	Do you have any artificial body parts? If yes, give list:	Yes	No
	Do you have a history of:
	Seizures	Yes	No
	Dizzy Spells	Yes	No
	Diabetes	Yes	No
	Hyperglycemia	Yes	No
	Seizure disorders	Yes	No
	Known brain wave abnormalities	Yes	No
	High blood pressure	Yes	No
	Fainting	Yes	No
	Asthma	Yes	No
	Heart Rhythm oddities If yes, give explanation:	Yes	No
	Do you have problems with circulation?	Yes	No
	Are you subject to leg cramps or charley horses?	Yes	No
	Do you have any foot problems?	Yes	No
	Do you have any hearing problems?	Yes	No
	Do you have an eye sight problems?	Yes	No
	Do you have any old injuries that still cause discomfort?	Yes	No
	Hyperventilation attacks?	Yes	No
	Describe any phobias:	Yes	No
	Dominant's medical conditions:
	Have you had any surgeries? If yes, list them:	Yes	No
	Do you have any surgical implants (breast, face, etc.)? Explanation:	Yes	No
	Do you have hemorrhoids? If yes, do you feel this will have an effect on our play?	Yes	No
	Are you, the dominant taking:
	Aspirin?	Yes	No
	Non-steroidal, anti-inflammatory drugs?	Yes	No
	Ibuprofen, Motrin, Naprosen, Aleve, Vioxx, Celebrex or other? These can cause a person to bruise quicker/easier with less impact/force then in "normal" play. Yes Dom/me's occasional miss and hit themselves.	Yes	No	Please list them:
	Are you taking anti-histamines? Examples; Benadryl, Hismanal, Atarax, Actifed, and Seldane These can cause blood pressure changes as well as changes in equilibrium.	Yes	No	Please list them:
	List any other medication you, the dominant are taking:
	Do you have any known allergies?	Yes	No
	Bandage tape?	Yes	No
	Nonoxynol-9	Yes	No
	Latex	Yes	No
	Food allergies? If yes, list them:	Yes	No
	Drug allergies? If yes, list them:	Yes	No
	Any allergy to any metals? If yes please list the metals:	Yes	No
	Any allergy to rubbing/isopropyl alcohol?	Yes	No
	Allergy to semen?	Yes	No
	Allergy to any lubes? If yes, list them:	Yes	No
	Allergy to any chemicals?	Yes	No
	Allergy to any animal?	Yes	No
	List any other allergies
	List any other medical conditions
	In case of emergency notify:
	Name and phone number of the medical general practitioner you would like called in an emergency visit to the hospital.	Phone#:
	What information is to be given in emergency?
	Any possibility you are pregnant?	Yes	No

7.	Sex	Dom/me	Dom/me	submissive	submissive
	Are you female?	Yes	No	Yes	No
	Are you male?	Yes	No	Yes	No
	Are you a TS?	Yes	No	Yes	No
	If yes, are you pre-op?	Yes	No	Yes	No
	If yes, are you Post-op?	Yes	No	Yes	No

	Age:
	Marital/Relationship Status.
	Single/Married/Civil Union/Significant Other/Domestic Partners/Legally Separated/In middle of divorce? Other?
	Monogamous?	Yes	No	Yes	No
	Sneaking behind partners back?	Yes	No	Yes	No
	Poly? If yes, Polyamory, Polyfidelity? Polysexual?	Yes	No	Yes	No
	Do you currently have a Body Fluid monogamy/Body Fluid bonding agreement with someone?	Yes	No	Yes	No
	Heterosexual	Yes	No	Yes	No
	Homosexual	Yes	No	Yes	No
	Bi-Sexual	Yes	No	Yes	No
	Try-Sexual	Yes	No	Yes	No

	Occupation:
	Height:
	Weight:
	Hair Color:
	Eye Color:
	Facial Hair:
	Any Piercings? If yes, where:
	Any tattoos? If yes, where?
	Any brandings? If yes, where?
	Characteristics (things you'd like known about you, physically):

		Dom/me	Dom/me	sub	sub
	When you climax are you considered one that needs waterproof sheets under you?	Yes	No	Yes	No

	Do you believe you might have?	Dom/me	Dom/me	sub	sub
	Trichomonas/Trichomoniasis or yeast infection? Explanation:	Yes	No	Yes	No
	Herpes? Explanation:	Yes	No	Yes	No
	Any STD? Explanation:	Yes	No	Yes	No
	Chlamydia? Explanation:	Yes	No	Yes	No
	Syphilis? Explanation:	Yes	No	Yes	No
	Gonorrhea? Explanation:	Yes	No	Yes	No
	PID (Pelvic Inflammatory Disease)? Explanation:	Yes	No	Yes	No
	TB (Tuberculosis)? Explanation:	Yes	No	Yes	No
	Tested positive for HIV/AIDS? Explanation:	Yes	No	Yes	No
	Date of last HIV test:
	Do you believe you might have Hepatitis?	Yes	No	Yes	No
	Have you have Hepatitis vaccination series? When? What type:	Yes	No	Yes	No

	Check off which of the following sexual acts that are acceptable to you.
	Dominant to submissive	Dom/me	Dom/me	sub	sub
	Masturbation	Yes	No	Yes	No
	Fellatio	Yes	No	Yes	No
	Cunnilingus	Yes	No	Yes	No
	Rimming	Yes	No	Yes	No
	Anal Fisting	Yes	No	Yes	No
	Vaginal Fisting	Yes	No	Yes	No
	Vaginal intercourse	Yes	No	Yes	No
	Anal intercourse	Yes	No	Yes	No

	submissive to Dominant
	Masturbation	Yes	No	Yes	No
	Fellatio	Yes	No	Yes	No
	Cunnilingus	Yes	No	Yes	No
	Rimming	Yes	No	Yes	No
	Anal Fisting	Yes	No	Yes	No
	Vaginal Fisting	Yes	No	Yes	No
	Vaginal intercourse	Yes	No	Yes	No
	Anal intercourse	Yes	No	Yes	No
		Dominant	Dominant	submissive	submissive
	Is swallowing of semen acceptable?	Yes	No	Yes	No
	Is oral sex without a barrier okay?	Yes	No	Yes	No
	Will any sex toys such as vibrators, dildoes, butt plugs, ben wa balls, etc. be used?	Yes	No	Yes	No
	Which of the above activities will involve birth control?
	What birth control are you using?
	Birth control pills	Yes	No	Yes	No
	Diaphragms	Yes	No	Yes	No
	IUD	Yes	No	Yes	No
	Spermicidal suppositories	Yes	No	Yes	No
	Lubricants containing nonoxynol-9	Yes	No	Yes	No
	Contraceptive foam/suppositories/gel?	Yes	No	Yes	No
	Which of the above activities will involve:
	Condoms-Male
	Condoms-Female
	Gloves
	Dental dams 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
	Submissive agrees to allow the following types of bondage:				Any explanations use this column?
	Hands in front	Yes	No	Wants to try
	Hands behind	Yes	No	Wants to try
	Ankles	Yes	No	Wants to try
	Knees	Yes	No	Wants to try
	Elbows	Yes	No	Wants to try
	Wrist to ankles	Yes	No	Wants to try
	Wrist to ankles (hog-tie)	Yes	No	Wants to try
	Spreader Bars	Yes	No	Wants to try
	Tied to a Chair (could be a massage chair also)	Yes	No	Wants to try
	Tied to a bed	Yes	No	Wants to try
	Tied to a table (could be a massage table type)	Yes	No	Wants to try
	Tied to a bench, wooden or metal horse, etc.	Yes	No	Wants to try
	Use of blindfold	Yes	No	Wants to try
	Use of gag	Yes	No	Wants to try
	Use of hood	Yes	No	Wants to try
	Use of rope	Yes	No	Wants to try
	Use of handcuffs/metal restraints	Yes	No	Wants to try
	Use of tape	Yes	No	Wants to try
	Use of leather cuffs	Yes	No	Wants to try
	Suspension	Yes	No	Wants to try
	Acceptable degree of immobility/helplessness:	Limited	Moderate	Extreme

10.	Pain/Erotic Pain

BDSM Education- Original Negotiation Form

I am the creator of the original D/s (BDSM) negotiation form. I first wrote the negotiation form in the 70's and published the negotiation form back in 1982/83.

So if you see my negotiation form (or part of it) on another BDSM site or the Internet without credit to me, please let us know. They are violating copyright laws.

Interested in learning more about copyrights? For your convenience here are a few links: http://whatiscopyright.org/ http://www.templetons.com/brad/copymyths.html

Interested in learning more about copyrights? For your convenience here are a few links:
http://whatiscopyright.org/ http://www.templetons.com/brad/copymyths.html