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Yes_____ No_____ Does the submissive suffer from carpal tunnel syndrome or any related problems?Yes_____ No_____ Explanation:___________________________________________________________ Describe any phobias:__________________________________________________ Submissive’s other medical conditions:_____________________________________ Any surgical implants (breast, face, etc.)?Yes_____ No_____ Explanation:___________________________________________________________ Have both parties been tested for Herpes?

Yes_____ No_____ Has any participant tested positive?

Yes_____ No_____ Explanation:___________________________________________________________ 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:____________________________________________________ Anything either party would especially like to try or explore?

Yes___ No___ Does everybody involved agree to discuss any mishaps in a constructive and non-blaming manner?

Yes_____ No_____ Any problems with the submissive’s: Explanation:___________________________________________________________ Does the submissive wear contact lenses?

________________________________________________ Will any permanent record, contracts, legally binding documents (photographs, audiotapes, videotapes, etc.) be made of the relationship?

Yes_____ No_____ Explanation__________________________________________________________ Who will be dominant?____________________________________________________________________ Outline the agreed methods of tracking progress: Outline the agreed methods of addressing concerns and making inquiries (submissive to Dominant): Outline the agreed forms of aftercare: Outline the agreed protocols for upholding physical, mental, and emotional health: Is swallowing semen acceptable? Yes_____ No_____ Will sex toys such as vibrators, dildos, butt plugs, etc. Yes/No If yes, describe:_______________________________________________________ Which of the above activities will involve birth control pills, diaphragms, spermicidal suppositories, lubricants containing nonoxynol-9, or contraceptive foams/suppositories/gels?__________________________________ Which of the above activities will involve condoms, gloves, dental dams, and/or other barriers?Yes_____ No____ Explanation:___________________________________________________________ May the submissive verbally resist?Yes_____ No_____ Explanation:___________________________________________________________ May the submissive physically resist?Yes_____ No_____ Explanation:___________________________________________________________ Will the submissive promptly obey?

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