| To each subject below put a number in front of it indicating how willing or how much you wish to do such a thing. YOUR Scoring as follows: 0 = violently oppose doing it, even when bound helpless, to the point of rebellion. 1 = will only do it if coerced/forced 2 = will do it but not enjoy it 3 = will do it but neither like nor dislike it 4 = will happily do the task 5 = love to do it, begging to do it MY scoring 0 = will never try it on a slave 1 = rarely... maybe only once 2 = seldom (maybe once a month) 3 = maybe once a week 4 = daily if possible 5 = as much as possible |
| PAIN Y/N--# -- Activity __/__ Belts __/__ Cane __/__ Cat (braided) __/__ Cat-on-nail (Flogger) __/__ Genital (weights) __/__ Genital (clothes pins) __/__ Genital (pins/needles) __/__ Genital whipping __/__ Riding Crop __/__ Paddle __/__ Spanking __/__ Tit (weights) __/__ Tit (cloth pins) __/__ Tit (pins/needles) __/__ Tit (rope) __/__ Torture rack __/__ Whip (single tail) __/__ Wooden Hair Brush SEXUAL Y/N--# -- Activity __/__ Anal sex __/__ Anal beads __/__ Anal plugs (small) __/__ Anal plugs (large) __/__ Anal fisting __/__ Anal (vibrator/dildo) __/__ Benwa balls __/__ Bisexuality __/__ Chastity Belt __/__ Hand jobs (giving) __/__ Hand jobs (receiving) __/__ Masturbation (self) __/__ Orgy (more then 3) __/__ Oral sex (giving) __/__ Oral sex (receiving) __/__ Rape Fantasy __/__ Swallow semen __/__ Swapping __/__ Threesomes __/__ Vaginal sex __/__ Vaginal fisting __/__ Vaginal (vibrator/dildo) __/__ Vaginal/Anal (same time) |
| FETISHWEAR Y/N--# -- Activity __/__ Corsets __/__ French maid __/__ Child/Baby __/__ High Heels __/__ Leather __/__ Lingerie __/__ PVC __/__ Rubber __/__ Slutty __/__ Spandex __/__ Thigh High boots __/__ Uniforms Victorian |
| HUMILIATION Y/N--# -- Activity __/__ Act as objects (ashtray, table, etc.) __/__ Age Play __/__ Boot worship _/__ Displayed to others __/__ Crawl on 4's __/__ Curtsy in public __/__ Enema __/__ Foot worship __/__ Forced nudity __/__ Forced masturbation __/__ Golden shower __/__ Harem--serving w/other(s) __/__ Medical Scenes __/__ Pet roles (act like a dog, cat, etc.) __/__ Pet play (forced sex w/pet) __/__ Scat Play __/__ Slave auction __/__ Spitting in face __/__ Serve others (supervised) __/__ Serve others (unsupervised) __/__ Serve as toilet __/__ Shave body hair(as in legs and armpits) __/__ Shave pubic hair __/__ Slap face __/__ Spanking (public) __/__ Stand in corner __/__ Swallow urine __/__ Take Pictures __/__ Take Video __/__ Verbal Abuse (slut, whore, etc.) __/__ Wear Collar everywhere __/__ Wear a leash __/__ Write on Body (slut, sissy, etc.) |
| BONDAGE Y/N--# -- Activity _/__ Arm Sleeves __/__ Blindfolds __/__ Breasts __/__ Gag __/__ Cage __/__ Chain __/__ Harness __/__ Hoods __/__ Immobilization (short time) __/__ Immobilization (long time) __/__ Leather cuffs __/__ Leather restraints __/__ Leg Sleeves __/__ Mask __/__ Mouth bits __/__ Nipple Clamps __/__ Rope __/__ Saran wrapping __/__ Scarves __/__ Shackles - __/__ Sling __/__ Spread bar __/__ Steel cuffs __/__ Steel restraints __/__ Stock __/__ Straight jacket __/__ Suspension (regular) __/__ Suspension (upside down) __/__ Tied to a cross |
| EDGE/MIND PLAY Y/N--# -- Activity __/__ Abrasion __/__ Asphyxia __/__ Branding __/__ Choking _/__ Cloth Pins __/__ Cutting __/__ Electric (violet wand) __/__ Electric (muscle stimulant unit) __/__ Flesh Hooks __/__ Hot wax _/__ Ice __/__ Knife play __/__ Needles __/__ Piercing __/__ Tattoo |
| CONTROL Y/N--# -- Activity __/__ Bathroom use control __/__ Dom(me) chooses food __/__ Dom(me) chooses cloths __/__ Eye contact restrictions __/__ Orgasm Control __/__ Orgasm Denial __/__ Permission to go out __/__ Sexual denial __/__ Speech restriction |
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