bdsm CONTACT FORM

note

I am a strict, sadistic & experienced domme.
I am not a switch & I am not submissive.

Screening is required in order to book with me.
Failure to submit screening will result in no reply back & the inability to book.

contact info

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booking details

TYPE OF CALL

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LENGTH OF BOOKING

LOCATION/CITY

DATE/TIME PREFERRED

OTHER INQUIRIES

SCREENING

ASK ANOTHER COMPANION THAT YOU'VE PREVIOUSLY SEEN IF YOU CAN USE HER AS A REFERENCE.

BE SURE TO PROVIDE YOUR REFERENCE(S)FULL NAME (EX 'NIKKI ROSE')& AT LEAST ONE FORM OF CONTACT (TXT/EMAIL)

REQUIREMENTS BELOW:
 
  1. MUST BE INDEPENDENT
    (I CANNOT ACCEPT AGENCIES)

     
  2. MUST BE A WELL KNOWN & VERIFIED OR WELL REVIEWED
     
  3. VISITED RECENTLY(WITHIN 4 MONTHS TIME)
    & HAVE VISITED THEM AT LEAST TWICE OR HAVE BEEN THEIR REGULAR

     
  4. YOU MUST HAVE NEWLY ASKED THEM FOR THEIR PERMISSION TO BE USED AS A REFERENCE

SELFIE OPTION A:
TAKE A SELFIE PICTURE HOLDING GOV'T ID(ONLY NAME, DOB & ID PICTURE NEED TO BE SHOWING. THE REST CAN BE COVERED)

SELFIE OPTION B:
HOLDING A SIGN WITH MY NAME & THE CURRENT DATE WRITTEN ON IT

REQUIREMENTS BELOW:
 
  1. SELFIE OPTION A:
    MUST BE GOVERNMENT ISSUED ID
    (DRIVERS LICENSE, PASSPORT, HEALTH CARD)

     
  2. SELFIE OPTION A:
    NAME, DOB & ID PICTURE MUST BE LEGIBLE
    (NOT DISTORTED OR BLURRY)

    SELFIE OPTION B:
    TEXT MUST BE LEGIBLE

     
  3. THERE SHOULD BE NO OBJECTS OBSTRUCTING YOUR FACE
    (EX HAT, SUNGLASSES, SCARVES, ETC)

     
  4. SELFIE MUST BE IN GOOD LIGHTING
    (NOT DARK, GRAINY OR BLURRY)

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other details

BDSM EXPERIENCE LEVEL

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ANY HEALTH CONDITIONS OR PHYSICAL LIMITATIONS?

WHAT TYPE OF SUB ARE YOU?
(CHOOSE ALL THAT APPLY)

WHAT ARE YOUR BDSM INTERESTS?
(pls use as many acronyms as possible & describe a type of scene you are interest in)

  1. A deposit is required & it's non-refundable if a cancellation occurs without 24HR notice

  2. I accept that Nikki Rose will not be deemed responsible for harm or injuries sustained during a mutually agreed session.

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