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Consultation or Scene Request
First Name
Preferred name
Email
Where would you like to session?
Dallas- domestic setting
Dallas -BDSM Furnished rented setting
I wish to fly you to Me (Expenses prepaid, plus 50% session deposit, 4 hour minimum.)
My Tour location- Hotel or kinkspace rental (List city below)
Dinner
Incall visit (Reserved for established clients ONLY)
Other (Explain Below)
Type of session you are requesting (click all that apply)
Domestic themed domination and BDSM
Spanking, paddling, corporal discipline
Public humiliation outing- 90 min minimum
Overnight extended session- 8-24 hours
Specific non-corporal punishment fetish (explain below)
A simple meet and greet (30-90 minutes)
A multi Domme session - 2 hour minimum
Nurturing touch/snuggle time 30 minute minimum
Coaching/Consulting/Service training
Specific roleplay (Explain below)
Beginners Day of Play- 3 Hour Minimum
Take Madame Navia out for dinner, cocktails or coffee
Couples coaching (2 hour minimum)
Phone or video consultation only, no roleplay
Other
The lady that I hope to meet is…
Sweet, kind, caring, nurturing
Strict, mean, cruel, unforgiving
Fun, flirty, giggly, realistic
Verbally aggressive/abusive, degrading, humiliating
Takes pleasure in my pain or predicament
A knowledgable educator
A character or other listed below
She is wearing...
Dress/ skirt &heels with hosiery and heels
Everyday clothes ( jeans/tshirt, work out attire, work clothes)
Pajamas, slip/robe (morning session)
Knee high Boots or heels
Flipflops, flats, Sandals or barefoot
Specific costume (PURCHASE EXPENSE must be prepaid)
Whatever she desires
Preferred Implements
Hand only
Wooden paddles, spoons
Leather belts, strap, whips
a cane
a hairbrush
a bathbrush
non-wooden paddles
Slipper
Electric items
Other, describe below
Do you desire/require bondage/restraint
Yes. Restraint desired
No thank you, its not necessary
Partial restraint
I'm curious
Rope Only
Leather straps or cuffs
Handcuffs
Soft restraints- scarves, stockings, etc
Body mark preference
No marks at all
Temporary 24-48 hr marks
Shorts/tshirt areas only
I WANT to be marked
Would you rather be spanked...
Fully clothed
Over Underwear
Bearing only my bare bottom
Bottomless
Completely stripped naked
Your Body Type
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What position do you feel would be best for you?
Over the knees- chair
Over the lap- Bed or couch
Bent over a table, chair, kneeler bench
Standing, bent over
Laying face down
Diaper position
What is your perceived pain tolerance?
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List all potential issues
Asthmatic
Sciatic or tailbone issues
Difficulty kneeling
Shoulder issues
I have none of these issues
Other (Describe Below)
How do you want to feel during the session?
Its just for fun, I just want to enjoy the sensation
Shame, guilt, remorse
Humiliation
Like a little kid
I want to be able to just let go and cry
I want to laugh and have fun
I want to escape reality for a moment
Aroused
Cared for, loved, nurtured
Like I have pleased You by taking what you've given
Other
Verbal interactions can be distracting or enlighten a scene. Do you prefer...
Silent scene. I like the mystery
I want to know what will happen and why
Scold me first, then punish me
Continue to scold me from beginning to end
I dont care for roleplay or talking
Other (Describe Below)
Do you feel that you need aftercare to process the scene?
How will I know you are enjoying the scene or want a change?
Your experience with professional BDSM. List bad experiences and/or references :
Specific session requests or roleplay scenarios here.
Submit to Madame Navia
You will get what you deserve soon
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