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Submissive Intake Form

You've expressed interest in submitting to me. I don't accept everyone. This form is your first act of obedience—a chance to show me you're serious, self-aware, and worth my time.

Answer honestly. Answer thoroughly. There are no wrong answers, only useful information. If your responses compel me, I'll send further instructions by email. If you don't hear back, understand the silence as:

I'm not interested. 🙏🏽

Part 1: Who You Are

Part 2: Your Experience & Desires

What experience do you have with D/s dynamics, discipline, and training?
None—this would be my first structured experience
Some casual play, but never a formal training program
Regular sessions with a Dom/me before
Extensive experience in long-term D/s relationships

Strict and sadistic? Warm but firm? Humiliating? Nurturing? Detached? Describe the energy you crave.


Be specific. I will respect these absolutely. Examples: blood, scat, public exposure, marks that last more than a day, verbal humiliation around specific topics, etc.

IThe more detail, the better I can assess fit. f a were a "sadistic disciplinarian." Tell me what that looks like in your mind. Impact play? Degradation? Chastity? Strict protocols? The more detail, the better I can design your program.

Are you interested in any of the following?

have you ever been plugged 24/7

This is confidential and affects how I design your training safely.

Part 3: Logistics

How often would you ideally like to serve or train?
Weekly
Bi-weekly
Monthly
Occasional / as available
Other

Days of week, times of day, any recurring conflicts I should know about.

Be honest. This helps me determine if what you want fits what I offer.

Are you open to paying a deposit to secure your first session?
Yes, absolutely
I have concerns (explain below)
No
What's your preferred method of communication between sessions?
Email
Text / WhatsApp
Signal / encrypted messaging
Voice notes
Whatever you prefer, Mistress

Part 4: The Extra Mile

What Happens Next

  1. Submit this form with honest, complete answers.

  2. I'll read it. If I'm intrigued, you'll receive an email with next steps—possibly including a deposit request to secure an initial session.

  3. If you don't hear back, understand the silence as: I'm not interested. No hard feelings. Not every sub fits every Domme.

This is not a negotiation. It's an application. You're asking for my time, my energy, and my dominance. Show me you're worth it.

— Mistress Haruhi


What time and date would you book?
Year
Month
Day
Time
HoursMinutes
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