(Please copy and paste into an email and return to Me, Mistress Vera promptly for consideration)

My email address is:


Date/Time/Duration you are requesting an audience with your Mistress (List All)______________________

Name and last initial______________________



Physical Description_____________________________________________________________

Marital Status__________

Financial Status and Employment Industry________________________________

Sexual Orientation__________________________

Medical Concerns/Physical Limitations_________________________________________________

Phobias/Abuse Issues__________________________________________



Can you be marked? If so, for how long?_______________________

How often do you wish to visit with Me, (Mistress Vera) Weekly? Bi-Weekly? Monthly? Bi-annually?_________________________________


Which attire do you prefer to see Me,(Mistress Vera) adorned in? (Please choose all that apply and delete the rest).
Latex dresses/skirts
Patent Leather
PVC/Vinyl pants/dresses/skirts
Business attire/suits
English riding apparel/boots
Corsets/waist cinches

Hosiery (please choose all that apply and delete the rest)
Cuban heel/seamed
Sheer black
Nude pantyhose
Black Knee-high
Bare legs/none

Shoes (please choose all that apply and delete the rest)
Thigh-high boots
Knee-high boots
High-heeled pumps (closed toe)
Peep-toe pumps or sandals (open toe)
Platform heels
Goth boots
Goth Platform shoes

Gloves (please choose all that apply and delete the rest)
Latex (opera length)
Leather (wrist length)
Satin (opera length)
Bare arms/none

In regard to My demeanor during the session, (i the submissive, would prefer:) (please choose all that apply and delete the rest)
Spoiled/Never satisfied

What best describes your reason for visiting Me? (please choose all that apply and delete the rest)
Suffering to please your Goddess and amuse Her (with disregard to my desires)___________________
Exorcism of guilt_____________
Other(please describe)_________________________

What would best describe the scenario you are seeking? (please choose all that interest you and delete the rest)
Schoolteacher/naughty boy
Female pimp/man-whore
Riding Mistress/ponyboy
Blackmailer/financial slave
Humiliatrix/small penis man
Mommy/Little boy
Other (please describe)_______________________________________________________

How long/often have you been involved in BDSM activities?_________

Do you have any other skills outside slavery that you can offer Me? How will you please your Mistress other than Her required tribute? (For example: Ability to make dungeon furniture/toys, ability/willingness to buy gifts, photgrapher/videographer, additional Tribute, chauffeur, chiropracter/massage therapist) __________________________________________


Do you have references from other Dommes (local,national or international)?__________________

Are you involved in any fetish/BDSM organizations? If so, which?_______________________________________________________


ACTIVITIES I AM INTERESTED IN: (please choose all that apply and delete the rest)
1.Bondage: Leather, Rope, Bondage tape, Saran wrap, Chains/Cuffs
Method: Light, Inescapable, Extended, Mummification

2.Corporal Punishment: Flogging, Whipping, Strapping, Spanking, Caning, Birching, Hairbrush

3.Genital Torture: Whipping, Chastity, Kicking/Kneeing,Trampling, Stretching/Weights, Chastity, Light touch cigarette, Hot wax, tight bondage/tying, manual squeezing/vise, slapping

4. Foot Worship: Stocking/Pantyhose, Shoe/Boot/Heel, Bare Feet, Clean or Dirty Feet
Method: Boot Licker, Toe Kisser, Masseuse, Footstool, Rug, Foot Licker/Toe Sucker

Method: (please describe)____________________________________

6.Domestic Service Training (must be available with 2-8 hours notice. If yes, choose): Chambermaid, Chauffeur, Foot slave, Dungeon Slut (forced-bi fantasy)

7.Shaving as form of humiliation or to please Mistress (yes or no, if yes choose): Genital area, Body_____________

8.Smoking Fetish (Mistress smokes) Yes or No: Human Ashtray Service______________

9.Puppy Training (yes or no, if yes choose): Caging, dog food eating, leash training, costuming, verbal command training

10.Pony Training (yes or no, if yes choose): Show pony, cart pony, riding pony)

11.Financial slave/Paypig/Blackmail (yes or no)___________

12.Cuckolding/Key-Holding CB-3000/6000/The Curve Long or short duration training

I love to entertain My guests at their expense. Are you comfortable being in a session/scene/show/party, with others for My benefit? If yes, choose:
Dominant Females
Dominant males
Submissive females
Submissive males

(Confidentiality is of supreme importance to your Mistress. I may use Masks to hide your identity).


All information held in the strictest of confidence by Mistress Vera. The name more and more Dungeon-going fetishists and submissives trust!

© 2018 by Mistress Vera Virgo Atlanta, Georgia

                             Adult Content Warning & Disclaimer

This website may contain partial nudity and is intended for adults only. It must not to be accessed by anyone under the age of 18 (or the age of consent in the jurisdiction from which it is being accessed).




I am over age 18 years old, and I have the legal right to possess adult material in my community. I will not permit any person(s) under 18 years of age to have access to any of the materials contained in this site. I am familiar with the rules governing the viewing or possession of Adult oriented materials as defined by my local jurisdiction. I will exit from this site immediately if I am in any way offended by the adult nature of any material. I understand and agree to abide by the standards and laws of my community. By logging on and viewing any part of this Web site, I agree that I shall not hold the owners of the Web site or its employees responsible for any materials located on the site. This entire website, including it's code, images, logos, and names are protected by copyright, and any infringement of said copyright will be prosecuted to the fullest extent of the law. The creators of this Web site along with the services provided are released of all liabilities.

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