BDSM Scene Negotiation Long Form

People

Who will take part?
Who will watch?
Note: The session will involve only those people named above.
Will any permanent record be made of the session (photographs, audio or video tapes)?

Roles

Who will be dominant?
Who will be submissive?
Type of scene:
  • master/slave
  • mistress/slave
  • captive
  • servant/butler/etc.
  • cross-dressing/gender play
  • age play
  • animal play
  • other:
Any chance of switching roles?
Will the submissive promptly obey?
May the submissive verbally resist?
May the submissive physically resist?
May the dominant "overpower" or "force" the submissive?
Does resistance equal a "strong yellow"?
May the submissive try to "turn the tables"?
Does the submissive agree to wear a collar?
The submissive agrees to address the dominant by the following title(s):

Place

Location:
Who will insure privacy?

Time

Begin at:
Length:
Beginning signal:
Ending signal:
Who will keep track of time?

Oops

Does everyone involved understand that there is some risk of accident, miscommunication, misperception and/or unintentional injury?
Does everyone involved agree to discuss any mishaps in a constructive and non-blaming manner?

STD's

Does any participant believe they might have a sexually transmitted disease?
Does any participant believe they might have herpes?
For females, when was your last PAP smear?
Have participants been tested for HIV?
Has any participant tested positive?

Limits

Submissive's physical/emotional/SM limits

Any problem with the submissive's:
  • Heart
  • Lungs
  • Neck/back/bones/joints
  • Kidneys
  • Liver
  • Nervous system/mental
Is the submissive wearing contact lenses?
Does the submissive suffer from carpal tunnel syndrome or related problems?
Does the submissive have a history of...
  • Seizures
  • Dizzy spells
  • Diabetes
  • High or low blood pressure
  • Fainting
  • Asthma
  • Hyperventilation attacks
Describe any phobias:
Submissive's other medical conditions:
Any surgical implants (breast, face, etc)?
Is the submissive taking aspirin?
Is the submissive taking ibuprofen, Aleve, or other non-steroidal, inflamatory drugs?
Is the submissive taking antihistamines?
Other medications the submissive is taking:
Allergic to:
  • Bandage tape
  • Nonoxynol-9
Other allergies:
In case of emergency notify:

Dominant's physical/emotional/SM limits

Any problem with the dominant's:
  • Heart
  • Lungs
  • Neck/back/bones/joints
  • Kidneys
  • Liver
  • Nervous system/mental
Dominant's other medical conditions:
Medications dominant is taking:
In case of emergency notify:
Is the dominant currently certified in First aid/CPR?
Safety gear on hand:
  • paramedic scissors
  • flashlight
  • fIrst aid kit
  • blackout light
  • fire extinguisher
Will the play be in an isolated area such as a farmhouse?
If yes, what will insure the submissive's safety if the dominant becomes unconscious?
  • No bondage to chair, bed, etc.
  • No gag
  • Silent alarm
  • Third person present
  • Telephone/radio/panic button within submissive's reach
  • Other:

Sex

Which of the following sexual acts are acceptable:
  • Masturbation
    • Dominant to submissive
    • Submissive to dominant
    • Self-masturbation by submissive
    • Self-masturbation by dominant
  • Fellatio
    • Dominant to submissive
    • Submissive to dominant
  • Cunnilingus
    • Dominant to submissive
    • Submissive to dominant
  • Analingus
    • Dominant to submissive
    • Submissive to dominant
  • Anal fisting
    • Dominant to submissive
    • Submissive to dominant
  • Vaginal fisting
    • Dominant to submissive
    • Submissive to dominant
  • Vaginal intercourse
    • Dominant to submissive
    • Submissive to dominant
  • Anal intercourse
    • Dominant to submissive
    • Submissive to dominant
Is swallowing semen acceptable?
Is any participant menstruating?
Will sex toys such as vibrators, dildos, butt plugs, etc be used?
Describe: Which of the above activities will involve birth control pills, diaphrams, spermicidal suppositories, lubricants containing nonoxynol-9, or contraceptive foam/suppositories/gel?
Which of the above activities will involve condoms, gloves, dental dams and/or other barriers?

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:

Bondage

The submissive agrees to allow (only) the following types of bondage:
  • hands in front
  • hands behind back
  • ankles
  • knees
  • elbows
  • wrist to ankles (hog-tie)
  • spreader bars
  • tied to chair
  • tied to bed
  • use of blindfold
  • use of gag
  • use of hood
  • use of rope
  • use of tape
  • use of handcuffs/metal restraints
  • use of leather cuffs
  • suspensIon
  • mummification with plastic wrap, body bag, or similar techniques
Any past bad experiences by either person with bondage, gags, blindfolds, and/or hoods?

Pain

Submissive's general attitude about receiving pain:
  • likes
  • accepts
  • neutral
  • dislikes
  • will not accept
Quantity of pain submissive wants to receive
  • none
  • small
  • average
  • large
Dominant's general attitude about giving pain:
  • likes
  • will give
  • neutral
  • dislikes
  • will not give
Quantity of pain dominant wants to give:
  • none
  • small
  • average
  • large
Will the "now" technique be used?
Will the "nod" technique be used?
Will the "one to ten" technique be used?
The following types of pain are acceptable:
  • spanking
  • paddling
  • whipping
  • caning
  • face slaps
  • biting
  • nipple clamps
  • genital clamps
  • clamps elsewhere
  • locations:
  • hot creams
  • ice
  • hot wax
  • tickling
Other types/methods of pain:
Additional remarks:

Marks

Is it acceptable to the submissive if the play leaves marks?
Visible while wearing street clothes?
Visible while wearing a bathing suit?
Other:
Is it acceptable to the submissive if the play draws small amounts of blood?
How easy or difficult has it been to mark the submissive in the past?

Erotic Humiliation

The submissive agrees to accept being referred to by the following terms:
The submissive agrees to the following forms of erotic humiliation:
  • "verbal abuse"
  • enemas
  • forced exhibitionism
  • spitting
  • water sports
  • scat games
  • other:
Any prior really good or bad experiences in these areas?

Safewords

Safeword #1 and its meaning:
Safeword #2 and its meaning:
Safeword #3 and its meaning:
Non-verbal safewords and their meaning:
Will "two squeezes" be used?
Will the "extended hand" technique be used?
Opportunities or special skills
Anything in particular either party would like to try or explore?

Follow-up

(Please include a note about who will initiate contact for each.)
After the session:
The next day:
A week later:
In case of a crisis:

Anything else?

What will become of this form after the session?

Post session notes

Dominant

Overall feeling (1 to 10, 10 best)
Best part (1 to 10)
Worst part (1 to 10)
Other comments:

Submissive

Overall feeling (1 to 10, 10 best)
Best part (1 to 10)
Worst part (1 to 10)
Other comments:


As published in "SM-101" 2nd ed. - Reproduced with permission.
Copyright 1996 by Jay Wiseman (Greenery Press) POB 1261, Berkeley, CA 94701

 

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