Consent form Please complete this form in order to meet with Mistress Alyssa. Your name: * First Name Last Name Emergency contact: (Name, relationship to you, phone number) BONDAGE Check all that interest you. Blindfolds Hood Collar/leash Leather cuffs Metal cuffs Gags Human-sized cage Mental SENSORY PLAY * Check all that interest you. Biting Electro play Hair pulling Simulated choking Nipples Playing with hair Tickling Scratching Light massage Sensory deprivation IMPACT PLAY Check all that interest you. Intro Spankings Floggers Paddles Canes Likes thuddy Likes stingy Light Medium Heavy MARKS Check all that interest you. None For today For a few days Longer ROLE PLAY Check all that interest you. Boss/employee Burgler/victim Doctor/patient Homeowner/maid Human furniture Pollice/convict Master/slave Owner/pet Teacher/student Little TOUCHING + INTIMACY Check all that interest you. Cuddling Kissing Dirty talk Humiliation Degradation Exhibitionism Orgasms Orgasm denial Withholding intimacy Giving oral sex Receiving oral sex Watersports Human urinal OTHER Check all that interest you. Edging Humiliation Degredation During the scene, you want to feel: Check all that interest you. Beautiful Cathartic Controlled Fearful Humiliated Degrated Energetic Erotic Helpless Masochistic Overwhelmed Peaceful Playful Submissive Things I need to know about your partner(s): Triggers What does subspace look like for you? Have you ever experienced subdrop? If yes, what does it look like for you? AFTERCARE Check all that interest you. Water Electrolytes Salty snack Sugary snack Blanket Comfort item Cuddling Let me be Conversation Service Snuggly clothes Socialize Checkin tomorrow Soft limits Hard limits Medical conditions/meds/allergies/injuries Are you able to provide your STI status? Anything other details you would like to share about yourself? Thank you! You’ve completed the Consent Form for Mistress Alyssa. Your answers are private.