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
	submissive's general attitude about receiving pain/erotic pain	Likes	Accepts	Neutral	Dislikes	Will Not Accept
	Quantity of pain/erotic pain submissive wants to receive Explanation:	None	Small	Average	Large	The more the better
	Dominant's general attitude about giving pain/erotic pain	Likes	Small	Average	Large	Erotic
	Quantity of pain/erotic pain dominant wants to give	None	Small	Average	Large	Watch Out!

	submissive agrees to accept the following types of pain/erotic pain:
	Spanking	Yes	No	Wants to try
	Paddling	Yes	No	Wants to try
	Whipping/Flogging	Yes	No	Wants to try
	Single Tail/Bullwhip/Signal Whip	Yes	No	Wants to try
	Caning	Yes	no	Wants to try
	Face Slaps	Yes	No	Wants to try
	Biting	Yes	No	Wants to try
	Clothespins	Yes	No	Wants to try
	Clothespins-nipple/breast	Yes	No	Wants to try
	Clothespins-genital	Yes	No	Wants to try
	Clamps	Yes	No	Wants to try
	Clamps-nipple/breast	Yes	No	Wants to try
	Clamps-genital	Yes	No	Wants to try
	Clamps any special location?
	Hot creams	Yes	No	Wants to try	< /td>
	Ice	Yes	No	Wants to try
	Hot Wax	Yes	No	Wants to try
	Chemical/Food/Plants	Yes	No	Wants to try
	Other types/methods of pain/erotic pain: Additional remarks:

11.	Marks
	Is it acceptable to the submissive if the play leaves marks?	Yes	No
	Visible while wearing street clothes?	Yes	No
	Visible while wearing a bathing suit?	Yes	No
	Other:
	Is it acceptable to the submissive if the play draws small amounts of blood? Explanation:	Yes	No
	Is it acceptable to the submissive if the play draws large amounts of blood? Explanation:	Yes	No
	Please be aware marks or drawing of blood can occur even when precautions are taken.
	How easy or difficult has it been to mark the submissive in the past?

12.	Erotic Humiliation
	The submissive agrees to accept being referred to by the following terms: (circle all that apply) Any others?	Cunt	Bitch	Some sub/slave/bottom name	slave	Slut
	The submissive agrees to the following forms of erotic humiliation:
	"Verbal abuse"	Yes	No	Wants to try
	Exhibition-private	Yes	No	Wants to try
	Exhibition-public	Yes	No	Wants to try
	Exhibition-play party	Yes	No	Wants to try
	Forced to dress in particular clothing to please the Dom/me	Yes	No	Wants to try
	Enemas	Yes	No	Wants to try
	Spitting	Yes	No	Wants to try
	Water Sports	Yes	No	Wants to try
	Scat games	Yes	No	Wants to try
	Any prior really good or really bad experiences in those areas?

13.	Safe Words
	Safe Word #1 and it's meaning: Pink A bit too hard/overwhelming I need a breather/need to catch my breath.
	Safe Word #2 and it's meaning: Red This isn't working...check in with me.
	Safe Word #3 and it's meaning: Black End NOW
	If I (the Dom/me) am not responding, have I heard you? Use my non scene name this will get my attention.
	Some dom/me's allow their sub to let them know when they hit an area the sub prefers them not too--use the word "Wrap"
	Non verbal safe words and it's meaning:
	Two-squeezes. The sub squeezes the Dom/me's hand, knee, arm whatever is negotiated--2 times and the Dom/me will check in with the sub.
	Ball in the hand, if sub drops the ball the Dom/me checks in with the sub.

14.	Opportunities/Special Skills
	Anything in particular either party would like to try and explore?

15.	Dominant
	Check which statement best suits you:
	I live D/s lifestyle every day in most activities
	I live D/s lifestyle 24/7
	I live D/s lifestyle frequently when in relationship
	I live D/s lifestyle occasionally in relationship
	I live D/s lifestyle in "scenes" or "play" only
	I use D/s only in "scenes" or "play"
	I do not live D/s lifestyle but would use "play" with correct submissive.
	Which best suits you:
	On-Line relationship only (may include web cam)	Yes	No
	On-Line/Phone Relationship only	Yes	No
	Real Time Relationship only	Yes	No
	On-line/Phone/Real Time Relationship Combination	Yes	No
	Do you currently have a sub/bottom/slave?	Yes	No
	Are you currently seeking a sub/bottom/slave?	Yes	No
	Can or would you travel to meet/be with a sub/bottom/slave?	Yes	No
	Would you have a sub/bottom/slave travel to meet/be with you?	Yes	No
	Have you had previous relationships:
	Real Life	Yes	No
	Only On Line (may include web cam)	Yes	No
	Only On Line and by phone	Yes	No
	If you answered yes to any of the above, how much experience?
	Are you experienced with:	How much experience?
	On-line D/s (may include web cam)
	Phone D/s
	Real Time D/s
	Previous Relationships:
	Have you had a collared sub/bottom/slave?	Yes	No
	Why did that relationship terminate?
	What's your current relationship with that sub/bottom/slave?

	What aspects of your sub/bottom/slaves life would you want to control? (check all applicable)
	Choose their clothing
	Choose their food
	Choose their daily activities
	Special occasion activities (non-sexual)
	Sexual activities
	Choose Social contacts
	Set Sleeping hours
	Bathing/toilet rituals
	Business/professional life
	Other:

	D/s Social:
	Would you like a sub/bottom/slave to perform the following and if so, how often (Rating scale: "O" (occasionally) "F" (frequently) "A" (at all times when applicable)
	Kneeling-clothed	O	F	A
	Kneeling-naked	O	F	A
	Wearing bondage outside "scenes" (crotch ropes, etc)	O	F	A
	Wearing toys outside "scenes" (nipple clamps, butt plugs, etc)	O	F	A
	Wearing toys/bondage in public (over clothing)	O	F	A
	Wearing toys/bondage in public (under clothing)	O	F	A
	Wearing toys/bondage in public (while naked--this could be at a play party)	O	F	A
	"Correct posture" outside "scenes" (to be defined)	O	F	A
	Sexual situations in public	O	F	A
	Wearing D/s collar in public	O	F	A
	Wearing D/s collar in private	O	F	A
	Performing "instructions" (delivered on-line/may include web cam or phone)	O	F	A
	Writing journal entries	O	F	A
	Would you require a standard form of dress for the sub/bottom/slave in private? (If so what?)	O	F	A
	Would you require a standard form of dress for the sub/bottom/slave in public? (If so what?)	O	F	A
	What form of address would you expect from the sub/bottom/slave for yourself and others? (check applicable)	Myself	Other Dom/me's	Other sub/bottom/slave
	Sir
	Ma'am
	Master
	Mistress
	First name
	Mr./Mrs./Ms.
	Other Males-Dom
	Other Males-sub/bottom/slave
	Other females-Domme
	Other females-sub/bottom/slave

	Would you desire to "share" your sub with others? If yes, state the circumstances and likely other partners (if known now).	Yes	No	Depends on situation
	Would you wish your sub/bottom/slave to have any of the following:
	Tattoo of ownership	Yes	No	Depends on situation	Probably at some point
	Branding of ownership	Yes	No	Depends on situation	Probably at some point
	Collar (or bracelet/ankle chain) worn 24/7	Yes	No	Depends on situation	Probably at some point
	Screen name changed to reflect ownership	Yes	No	Depends on situation	Probably at some point

	List any "scene" or "play" which you WOULD NOT DO under any circumstances.

	PUNISHMENTS
	What forms of punishments would you use on a disobedient sub/bottom/slave: (this is NOT play punishment)
	Writing assignments	Yes	No	Depends on situation
	Meditation	Yes	No	Depends on situation
	Corporal Punishment (caning, whipping, etc)	Yes	No	Depends on situation
	Time out, in the corner, or kneeling looking at the floor	Yes	No	Depends on situation
	Spanking, naked kneeling or standing nose to the wall	Yes	No	Depends on situation
	Bondage (any form)	Yes	No	Depends on situation
	Removal of privileges	Yes	No	Depends on situation
	Loss of contact with you	Yes	No	Depends on situation
	Specific Dress	Yes	No	Depends on situation
	Withholding orgasms/pleasure	Yes	No	Depends on situation
	Other:
	Note: All of the above should be within negotiated limits

	What forms of rewards would you give a pleasing sub/bottom/slave:
	Small "presents" (candy, flowers, etc)	Yes	No	Depends on situation
	Additional "play" (something special they have been wanting)	Yes	No	Depends on situation
	Additional "play" time with you	Yes	No	Depends on situation
	Personal mementos (letters to them, etc)	Yes	No	Depends on situation
	Going somewhere with them	Yes	No	Depends on situation
	Time away (mini vacation) with them	Yes	No	Depends on situation
	Free access/unrestricted access to your body	Yes	No	Depends on situation

	More about you:
	Non-D/s interests/hobbies:
	Favorite music:
	Favorite reading:
	Favorite non-D/s leisure time activities:
	Any other information you would like to supply regarding yourself:

16.	Submissive
	Check which statement best suits you:
	I live D/s lifestyle every day in most activities
	I live D/s lifestyle 24/7
	I live D/s lifestyle frequently when in relationship
	I live D/s lifestyle occasionally in relationship
	I live D/s lifestyle in "scenes" or "play" only
	I use D/s only in "scenes" or "play"
	I do not live D/s lifestyle but would use for "play" with correct Dominant.
	Which best suits you:
	On-Line relationship only (may include web cam)	Yes	No
	On-Line/Phone Relationship only	Yes	No
	Real Time Relationship only	Yes	No
	On-line/Phone/Real Time Relationship Combination	Yes	No
	Do you currently have a Dom/me?	Yes	No
	Are you currently seeking a Dom/me?	Yes	No
	Can or would you travel to meet/be with a Dom/me?	Yes	No
	Would you like a Dom/me travel to meet/be with you?	Yes	No
	Are you experienced with:			How much experience?
	On-line D/s (may include web cam)	Yes	No
	Phone D/s	Yes	No
	Real Time D/s	Yes	No
	Previous Relationships:
	Have you had a collar from a Dom/me?	Yes	No
	Why did that relationship terminate?
	What's your current relationship with that Dominant?
	Have you had previous relationships:
	Real Life	Yes	No
	Only On Line (may include web cam)	Yes	No
	Only On Line and by phone	Yes	No
	What aspects of your sub/bottom/slaves life would you want controlled by your Dom/me? (check all applicable)
	Choice of clothing
	Choice of food
	Choose your daily activities
	Special occasion activities (non-sexual)
	Sexual activities
	Choose your social contacts
	Set Sleeping hours
	Bathing/toilet rituals
	Business/professional life

	What kind of "play pain" do you enjoy?
	Sting	Yes	No	Don't know
	Thud	Yes	No	Don't know
	Combination Thud and Sting	Yes	No	Don't know
	What items do you consider Stingy?
	What items do you consider Thuddy?
	What items do you consider both Stingy and Thuddy?
	List any "scene" or "play" activities which you WOULD NOT DO under any circumstances:
	Would you desire to be "shared" with others?	Yes	No	Depends on the situation
	Shared with:
	Female Dominants	Yes	No	Willing to for Dom/me
	Female subs/bottoms/slaves	Yes	No	Willing to for Dom/me
	Male Dominants	Yes	No	Willing to for Dom/me
	Male sub/bottom/slaves	Yes	No	Willing to for Dom/me
	Would you have any of the following done for your Dominant?
	Being pierced?	Yes	No	Depends on situation
	Tattoo of ownership?	Yes	No	Depends on situation
	Branding of ownership?	Yes	No	Depends on situation
	Collar (bracelet or ankle chain) worn 24/7	Yes	No
	Screen name change to reflect ownership	Yes	No	Depends on situation

	PUNISHMENT
	What would be punishment to you?: (this is NOT play punishment)
	Writing assignments	Yes	No	Depends on situation
	Meditation	Yes	No	Depends on situation
	Corporal Punishment (caning, whipping, etc)	Yes	No	Depends on situation
	Time out, in the corner, or kneeling looking at the floor	Yes	No	Depends on situation
	Spanking, naked kneeling or standing nose to the wall	Yes	No	Depends on situation
	Bondage (any form)	Yes	No	Depends on situation
	Removal of privileges	Yes	No	Depends on situation
	Loss of contact with Dom/me	Yes	No	Depends on situation
	Specific Dress	Yes	No	Depends on situation
	Withholding orgasms/pleasure	Yes	No	Depends on situation
	Other:
	Note: All of the above should be within negotiated limits

	What would you consider a reward for you?
	Small "presents" (candy, flowers, etc)	Yes	No	Depends on situation
	Additional "play" (something special you have been wanting your Dom/me to do)	Yes	No	Depends on situation
	Additional "play" time with Dom/me	Yes	No	Depends on situation
	Personal mementos (letters to you, etc)	Yes	No	Depends on situation
	Having the Dom/me take you somewhere	Yes	No	Depends on situation
	Time away (mini vacation) with Dom/me	Yes	No	Depends on situation
	Free access/unrestricted access to your Dom/mes body	Yes	No	Depends on situation
	Postcard from the Dom/me when they are away	Yes	No	Depends on situation
	A romantic dinner out with the Dom/me	Yes	No	Depends on situation
	Endorphin Flogging	Yes	No	Depends on situation
	Oral pleasure from Dom/me to you	Yes	No	Depends on situation
	Other please state:

	More about you:
	Non-D/s interests/hobbies:
	Favorite music:
	Favorite reading:
	Favorite non-D/s leisure time activities:
	Any other information you would like to supply regarding yourself:

17.	Follow Up
	After the session we need a coming down period. The next day we should discuss how things went. A week later touch in again/follow up.
	In case of crisis:

18.	Anything else?
	Dominant Post-session notes:
	Best Part:
	Scale 1-10 (10 being tops)
	Worst Part:
	Scale 1-10 (10 being tops)
	Most memorable part:
	Scale 1-10 (10 being to tops)
	Other comments:

	sub/bottom/slave Post-session notes:
	Best Part:
	Scale 1-10 (10 being tops)
	Worst Part:
	Scale 1-10 (10 being tops)
	Most memorable part:
	Scale 1-10 (10 being to tops)
	Other comments:

19.	Please answer these questions completely honestly. Please use a separate sheet(s) of paper.

A.	What is it about yourself that attracts you to the BDSM play scene?

B.	What is it about yourself that attracts you to the BDSM lifestyle?

C.	What does being a sub/bottom/slave mean to you?

D.	What fantasies have you had that relate to BDSM lifestyle?

E.	Describe a scene you would find to be highly erotic, satisfying and descriptive of the role you wish to assume in BDSM.

F.	Describe a scene you would find to be non-erotic, non-satisfying and descriptive of the role you wish to assume in BDSM.

G.	Describe a scene you would find completely out of bounds or off limits as far as your current disposition and understanding are concerned.

H.	What is it about me that makes you think I would be the right Dom/me for you?

I.	What sexual fantasies have you had that relate to BDSM?

J.	What non-sexual fantasies have you had that relate to BDSM?

K.	List the erotic and sexual toys and devices you currently own:

Disclaimer:
By filling this form out and returning it, I am doing so with full knowledge and with a competent mind. It is my understanding that the form is used for social purposes only and for my benefit. I also understand that the persons or persons who are to be handling the form will do so with confidentiality and with no malicious intent. I am stating that I am over the consenting age of the state or country that I live in and I am an adult. I will not hold anyone financially or legally responsible should an incident of misfortune arise. By submitting this form I release all liability and do so at my own risk.

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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

For more information on the topic above and/or the example of what could occur see Electric Switch's book.

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