Secure Application Form

Secure Application Form

Use this form when you are ready to request an appointment. Serious applicants will receive a prompt response.
If you would like to ask questions by email before applying, Mistress Katja's assistant will be happy to help you. Click here to ask a question.
If you would like a phone consultation with Mistress Katja before applying, click here.
For your privacy, all information on this form will be encrypted and sent to a secure email address. (Why is this secure?)

Mistress Katja is selective in accepting new clients.
Take time to fill out this application thoughtfully, so that your compatibility with the Mistress may be fully considered.
Novices are not expected to be able to answer every question.

Name
City and state of residence
Preferred city, date/s and time/s for your appointment. (See calendar for travel locations, appointments should begin between 2pm-8pm if possible.)
Second best date/s and time/s, if your preferred appointment is not available?
Email address
Phone number
How would you like to be contacted?	Phone Email
If you checked "Phone," what time/s of day may you be reached?
Is it ok to leave a message?	Yes No
How did you hear about Mistress Katja?
Gender:
Age:
Height and weight:
Approximately how much experience do you have with pro Dommes?
Can you provide references from other pro Dommes? (Name, location, and contact info.)
Do you have BDSM experience outside of pro sessions?
Why do you want to see Mistress Katja in particular?
Describe a favorite fantasy:
What would make an experience with a Domme especially great for you?
What would make the experience "bad"? Describe anything from past sessions that didn't work for you.
	Check any of the below that apply It's OK to check more than one
I respond best to a Domme whose demeanor is:	Friendly and conversational Forceful and strict Capricious and playfully unpredictable Maternal Gently controlling Highly controlling Friendly and conversational Condescending Disdainful Sensual and seductive Don't know
How do you like to feel in a scene?	Physically restrained and tormented Trained and controlled Seduced and teased Objectified Embarrassed Deeply ashamed Used Slutty In "subspace" Little (age regression) Playful Serious Frightened Cared for Surprised Coerced Tricked Forced Intimidated Natural/casual Don't know
Would you identify yourself as:	Bottom Submissive Masochist Slave Slut/bitch Servant Crossdresser/sissy Kitten, puppy or other animal role Age-player Adult baby Other Not sure
How long have you felt this way? Describe how your feelings began and evolved:
	Share some details about your desires concerning any of the below Leave sections blank if they don't apply Links open a glossary of BDSM terminology
Describe any desires you have around physical torment/ corporal punishment:
Describe any desires you have around bondage or other physical restraint/control:
Describe any desires you have to be controlled psychologically:
Describe any desires you have for feminization, crossdressing, or other gender play:
Describe any desires you have around domestic control or discipline:
Describe any desires you have around age regression play:
Describe any desires you have for chastity control, orgasm control, or chastity regimens:
If you desire humiliation, describe what type of embarrassment is erotic for you:
Describe any desires you have around objectification:
Describe any interest that you have in pet training (kitten, puppy, pony):
Describe any fetishes:
Describe any interest you have in role play:
Costume fetishes or requests?	Little black dress High heels Boots Gloves Cat suit Leather Office Teacher Mommy Vinyl Nurse/Doctor Whatever pleases You, Ma'am Other:
	Limits and health considerations
Describe your limits: (What you DON'T want to do.)
Health issues (Be totally honest)	Contact lenses, glasses, other vision Hearing Back Joints Neck High blood pressure Low blood pressure Low blood sugar Knees Heart problems Diabetes Asthma Seizure disorder Pacemaker Plates, screws, or other metal in the body Serious psychological issues Mental illness, diagnosed or otherwise Allergies Explain any of the above: Have you ever fainted? Explain:
Do you have any phobias, major past traumas, or known psychological "triggers?" Explain.
List any and all prescribed medications you are currently taking, including Viagra or other stimulants.
Additional Comments/questions: