Member Form

So you always get the best possible session and personalized treatment from your Dom, sub, or switch, we like to keep your questionnaire on file. If this is your first visit to Wicked Eden, we ask that you fill out this questionnaire online.

Please note: This questionnaire is VERY comprehensive, and may contain activities that you do not have an interest in. Please fill it out as thoroughly as possible so your preferred staff member has a good idea of your likes and dislikes before you begin your interview and can refer to your form for subsequent appointments. (Remember, even the best Dominant or submissive is not a mind-reader.)

A. Personal Information    

None of the below information is required with the exception of your name, age, and contact information. If you do not wish to share these details with us, please mark that box "Not Applicable." We do not share information with third-parties of any sort, this information is simply used for internal purposes (such as zip codes for travel notifications, need for discretion for married individuals, etc). Required fields are marked with *.
First Name: *
Last Name: * (last initial required)
Your Email: *
Please verify your email: *
Note: Please double-check this address is correct. If you do not have a personal email account, we suggest using Yahoo Mail or GMail to setup a free account. Remember that an email address is: name@domain.com.

_______________________________________________________________
Phone Number:
Number Type:
Alternate Phone:
Number Type:
Note: All phone numbers are kept strictly confidential.
Can We Leave a Message?

 Yes         No

Preferred Method of Contact: *     
Home City:
Zip Code:
State/Province:
Age: *

_______________________________________________________________
Marital Status:
Does your partner know?  Yes         No
Note: If your spouse/partner will be attending Wicked Eden in any fashion, please provide his or her name and email below so we can link your forms. Otherwise, you may leave these fields blank.
Partner's Name:
Partner's Email:

_______________________________________________________________
Occupation:
Income Level:
Is there any additional information you'd like to provide concerning your personal situation? (Work schedule, discretion, etc.)
Do you have any health issues that would affect your play? (Please include such things as medications, high blood pressure, etc. These are important to know in case of an emergency.)

B. Orientation    

Don't know what something means? See the BDSM Definitions Page.
Gender:
Your Sexual Orientation is:
Your D/s Orientation is:

C. Erotic Fetishes Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.

Note: Wicked Eden does not provide sexual services in any fashion. We are an erotic entertainment and educational facility that acts in accordance with local laws and regulations. These questions are here for purposes of understanding your fantasies. If the fetishes below do not apply to your gender, mark them "N/A."
 
Anal Penetration Yes No N/A
Anal Fisting Yes No N/A
Double Penetration (oral/vaginal) Yes No N/A
Double Penetration (oral/anal) Yes No N/A
Double Penetration (vaginal/anal) Yes No N/A
Masturbation Yes No N/A
Nipple Stimulation/Torture Yes No N/A
Orgasm Control Yes No N/A
Teasing Yes No N/A
Same Gender Sex Yes No N/A
Triple Penetration (female) Yes No N/A
Oral Penetration (dildo/strap-on) Yes No N/A
Vaginal Penetration Yes No N/A
Vaginal Fisting Yes No N/A
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

D. General Fetishes Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.
 
Body Modification * Yes No
Bondage Yes No
Boots Yes No
Corsetry Yes No
CFNM (Clothed Female Naked Male) Yes No
Food Play / Splosh Yes No
Cross Dressing Yes No
Diapers / Infantilism Yes No
Enemas Yes No
Exhibitionism Yes No
Forced Feminization Yes No
Golden Showers Yes No
Lace / Feminine Yes No
High Heels Yes No
Latex / Rubber Yes No
Leather Yes No
Legs & Feet Yes No
Medical / Dental Yes No
Silk or Satin Yes No
Highly Restrictive Bondage (immobilization) Yes No
Panties Yes No
Pantyhose / Stockings Yes No
PVC/Vinyl Yes No
Scat / Brown Showers Yes No
Smoking Yes No
Wrestling / Physical Domination * Yes No
Voyeurism Yes No
Watersports Yes No
Total Power Exchange Yes No
Strap-On Play Yes No
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

E. D/s Activities Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.

Items listed with a * may only be performed by a staff member
who has been specifically trained in that activity, for safety reasons.
Branding / Permanent Marking * Yes No
Body Worship Yes No
Caging Yes No
Collar and Leash Yes No
Chastity Devices Yes No
Body Worship Yes No
Collars Yes No
Domestic Service Yes No
Corporal Punishment * Yes No
Dress Codes Yes No
Eye Contact Restriction Yes No
Following Orders Yes No
Forced Servitude ("non-consensual slavery") Yes No
Given Away (for play or training) Yes No
Housework/Chores Yes No
Posture Training Yes No
Slave Training Yes No
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

F. Humiliation Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.
Bathroom Use Control Yes No
Begging Yes No
Forced Homosexuality Yes No
Forced Masturbation Yes No
Forced Feminization Yes No
Forced Nudity Yes No
Mouth Soaping Yes No
Private Humiliation Yes No
Public Humiliation Yes No
Serving as Ashtray Yes No
Serving as Furniture Yes No
Toilet Service Yes No
Verbal Humiliation Yes No
Small Penis Humiliation Yes No
Cuckolding Yes No
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

G. Bondage Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.

Items listed with a * may only be performed by a staff member
who has been specifically trained in them, for safety reasons.
 
Arm Sleeves Yes No
Blindfolds (sensory deprivation) Yes No
Body Bags / Sleepsacks Yes No
Body Harness (leather) Yes No
Body Harness (rope) Yes No
Breast Bondage Yes No
Casts Yes No
Duct Tape Yes No
Cock and Ball Bondage * Yes No
Restraints (leather) Yes No
Restraints (metal) Yes No
Plastic Bags Yes No
Head Harnesses Yes No
Hogtie Yes No
Hoods Yes No
Mummification Yes No
Gags Yes No
Saran Wrapping Yes No
Shackles (metal) Yes No
Slings/Swings Yes No
Spread Eagle Yes No
Spreader Bars Yes No
Stocks Yes No
Straight Jackets Yes No
Suspension (horizontal) * Yes No
Suspension (inverted) * Yes No
Suspension (vertical) * Yes No
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

H. Toys & Equipment Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.

Items listed with a * may only be performed by a staff member
who has been specifically trained in that activity, for safety reasons.
 
Belts/Straps Yes No
Bare Hands Yes No
Ball Stretchers & Crushers Yes No
Butt Plugs Yes No
Blindfolds Yes No
Branding Irons * Yes No
Boot/Heel Crushing or Kicking * Yes No
Canes (rattan, hardwood, bamboo) Yes No
Clips and Clamps Yes No
Clothespins Yes No
Dildos - By Hand/Device Yes No
Dildos - Strap-On Yes No
Fire/Heat * Yes No
Floggers (leather) Yes No
Floggers (rubber) Yes No
Hot Wax Yes No
Ice Yes No
Inflations (saline) * Yes No
Belts and Straps Yes No
Medical/Dental Equipment Yes No
Needles * Yes No
Nipple Clamps Yes No
Oils/Lotions/Spices Yes No
Paddles (leather) Yes No
Paddles (wood) Yes No
Riding Crops Yes No
Single Tail Whips * Yes No
Speculums Yes No
Suction Devices Yes No
TENS/Electrical Units * Yes No
Ticklers Yes No
Urethral Sounds * Yes No
Vibrators Yes No
Violet Wand Yes No
Gags - ball, bit, cleave Yes No
Gags - open-mouth, ring, funnel Yes No
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

I. Scenes Done It Before? Rate It

Don't know what something means? See the BDSM Definitions Page.

Rate each item from 1 to 5, with 1 being little to no interest, and 5 being maximum interest. Indicate "Limit" for activities you do not wish to be involved in, under any circumstances.

Items listed with a * may only be performed by a staff member
who has been specifically trained in that activity, for safety reasons.
 
Abduction Scenes Yes No
Age Play Yes No
Blood Play * Yes No
Branding Scenes Yes No
Breath Control / Asphyxiation * Yes No
CBT Scenes (Cock & Ball Torture) * Yes No
Electro Torture Scenes * Yes No
Interrogation Scenes Yes No
Intricate Bondage Scenes Yes No
Medical Scenes * Yes No
Needle Play (temporary piercing) * Yes No
Pony Play Yes No
Puppy Play Yes No
Religion Scenes Yes No
Resistance Play (being "forced") Yes No
Role Playing (general) Yes No
Sensory Deprivation Scenes Yes No
Service Scenes Yes No
Spanking Scenes Yes No
Tease and Denial Yes No
Tickling Scenes Yes No
Torture Scenes * Yes No
Vampire Scenes * Yes No
Videotaped Scenes Yes No
If you would like to expand on a particular fetish above, do so here :
(example: anal with a gloved finger, but no toys)

J. Additional Information Done It Before? Rate It

 

Pain Enjoyment Level
Please describe one or more strong fantasies that you have concerning BDSM:
(Please feel free to write as much as you like, there is no character limit.)
How much experience do you have?
Can you have marks/bruises?
What orientation do you prefer in a playpartner?
Are you interested in being in fetish videos or photos?

* Note: Wicked Eden does not film or photograph members or sessions without their permission and signed model releases.
Have you had any poor experiences or situations you would like to avoid?
Any fetishes/interests not listed above?
What is your reason for coming to Wicked Eden?
Where did you find or hear about us?
   
 

 

Disclaimer & Terms of Agreement

By filling out this form and submitting it, you are stating that you are age 18 or over and that viewing this website is legal in your local jurisdiction. You state that the information above is accurate and belongs solely to you. The information collected by Wicked Eden is used solely for the creation and maintenance of your membership, to give each individual a more personalized and discreet BDSM experience. Your information will always remain confidential, as your privacy is one of our utmost concerns. WE DO NOT sell, loan, lease, swap, trade or otherwise disclose your personal data. To prevent unauthorized access, maintain data accuracy, and ensure the correct use of information, we have put in place appropriate physical, electronic, and managerial procedures to safeguard and secure the information we collect online.