Getting to Know You Before We Have Sex Application
Getting to Know You before We have Sex Application (Long Form)
Purpose: To screen potential sexual partners.
Directions: Please read though the questions carefully before answering them. Answer all
questions honestly and to the best of your knowledge.
General Information Section
Last Name: ___________________ First Name _____________ Nick Name _______________
Gender Male __ Female __ Age: ____________ Height Feet ___ Inches___ Weight______ lbs.
Breast Cup Size ____ Waist ______ Hips ______
Endowment: Extra Small __ Small __ Medium __ Large __ Extra Large __ Enormous __
Phone: (____) ____________ e-Mail: ___________________________@ ________._____
Highest Educational Level: 8th Grade or Less __ High School or less___ High School Grad ___
Some College ___ College Degree __ Masters Degree ___ Post Grad ____ Professional __
Occupation: ____________________
Married ____ Single ___ Divorced ___ Separated ___Other____ In A Relationship_____
Sexual Orientation:
Straight ___ Gay ____ Lesbian ___ Bi- Sexual ____ Tri- Sexual (Try Anything) ___
Are you into Sadomaochism(BDSM)? No __ Ye s __ Which One? Sadism ___ Masochism ____
Place a “X” in the correct answer space and write in the answer if applicable.
If more than one answer applies, Check All that Apply
Have you been arrested or convicted of any sex crimes? No __ Yes ___ (If yes, stop here turn in
application)
Do you have any history of serious mental illness? (If yes stop here turn in application)
Did you ever have a sex change operation? No __ Yes __ (If yes stop here turn in application)
Have you ever been alien a*****ed and anally probed? No __ Yes __ ( If yes stop here turn in
application)
Do you like having sex with minor k**s? No ___ Yes __ ( If yes stop here turn in application
Do you have any sexually transmitted diseases? Yes ( If yes stop here, return appl. ) ___ No ___
What age did you start having sex with someone other than yourself? ____
When was the last time you had sex? Today ___Yesterday ___ Last Week ___ Last Month ___
More than a month ago ___ More than a year ago ___
Do you use birth control? No __ Yes __ What Type ___________
Do you use condoms? Yes __ No __
Ever have any STD’s? No ___ Yes ____ Which Diseases? 1. ______________ 2. ____________
How many sexual partners have you had? 0 __ 1 __ 3 to5 ___ 6 to 10 ___ 10 to 15 ___ 15 to 20
___ 25 to 35 ___ 36 or more __ More than you can remember ____
Are you a premature ejaculator? Yes __ No __
Have you ever been stuck together? Yes ___ No ____
Do you sweat when having sex? Yes ___ No ___
What type of nipples do you have? Pointy ___ Short ___ Stubby ___ Inverted ___
What type of pubic hair do you have? Shaved ___ Bush ___ Weave ___ Mohawk ___________
Any Tattoos? Yes _____ Where ________ No _____ Want any? Yes __ No __
Any Piercings? Yes ___ No ___ Want any? Yes ____ Where ____________
Any Brandings? Yes ___ No ___ Want any? Yes ____ Where ____________
Do you like Giving Oral Sex ? No __ Yes __ Receiving Oral Sex? Yes – No ___
Do you Swallow? Yes __ No __ Sometimes __Are you a spitter? Yes ___ No ___ Sometimes __
Do you do Anal? Yes __ No __ Special Occassions __
Do you spank or like to be spanked? Yes ___ No ___ OPM (Other People’s Monkey)__
Do you spank your monkey or choke your chicken? Yes __ No __
Do you like to shower before sex? Yes ___ No (It removes the flavors) ___
Do you like to be tied up? Blind folded? ____ Bitten? ____ Toys? ____
Do you like the lights on or off? On __ Off ___
Do you like clothes on ____ Partially on ____ Butt Naked ____
Do you like to involve food in your sessions? Yes ___ No ___
Do you have any sexual photos or video of yourself? No __ Yes __ Want to make some ___
Which do you prefer? One on one__ Doubles__ Triples __ More than 3 People __ Group___
While having sex, what do you do? Faint__ Cry__ Moan__ Wiggle__ Twist__ Jerk about__ Jerk Off
__ Pant__ Sweat___ Scream__ Squirt ___ Hum__ Whistle__ Just lie there__
How do you like your sexual action? Oral ___ Anal ___ Intercourse ___ Oral only ___ Intercourse
Only ___ All of the Above ___ All the above minus Anal ___
When you are about to cum do you? : Kick and bite.__ Scratch and Scream.__ Kiss and Lick.__ Push
back with increasing determination__ Fart __
When you are having sex do you? Scream.__ Moan __ .Fart __ Bite and scratch ___
How do you prefer your partner? Small.__ Medium.__ Large __ Skinny.__ Wet.__ Thick __ Tight
Long __ Stubby __ Pencil Dick ___
Availability, Frequency, Duration, and Tendencies Section
How often do you want to have sex ? Daily__ Weekly__ Monthly__ As much as possible__
How long can you last? 1min ___ 15min__ 30min__ 1hr__ all night___
Do you prefer Evenings _____ Mornings ____ Nooners (Lunch time) _____
When are you available? 8-12am__ 1-5pm__ 6-10 pm __ all night __ Midnight – 8 am __
Do you like to have sex: Outdoors _____ Indoors ____ In the Shower ___ In a Car _____
Do you talk during sex? Yes __ No __ Can’t talk because your mouth is full __ Can Talk
(Ventriloquist) ____
Do you like to talk dirty? Yes __ No__ Sometimes__ Always__
Skills and Talent Inventory Assessment Section
Do you like to role play? Yes __ No __
Do you like the movie “Deliverance”? Yes __ No ____
Can you squeal like a pig? Yes __ No __
What’s your favorite body parts in order? ( 1 being best 5 being last)
Butt __ breast ___ Chest ___ Mouth ___ Penis ___ Vagina ___ Ears ___ Eyes __
What’s your favorite hole? 1. _____________ 2. ____________ 3. ______________
Have you ever had sex with an a****l live or other wise? Yes __ No __
Do you like to kiss? Yes __ No ___ (If no stop here)
Are you tight or loose? Tight ___ Loose ___ Uptight ___ Other ___________
Did it ever go in the wrong hole? No ___ Yes ____ Explain __________________________
Any weird sexual fetishes? ATM ___ Fisting ___ Golden Showers ___ Brown Showers ___ Baby
Diapers __ Other 1_____________ Other 2 _________________ Other 3 _________________
Do you like inter-racial sex? No __ Yes ___ Preference 1 ___ ___ Preference 2 ____________
Do you like sex with clowns? No _____ Yes _____ Never tried but would like to ____
Do you like sex with midgets? No _____ Yes _____ Never tried but would like to ____
Do you like sex with amputees? No _____ Yes _____ Never tried but would like to ____
Do you like sex with handicapped? No _____ Yes _____ Never tried but would like to ____
Are you handicapped? No__ Yes __ Explain ________________________________________
Do you have big hands and feet? No __ Yes __ If yes explain __________________________
Can you hold a “Q-Tip” in your coochie __ booty __ None __
Do you like sexy lingerie? Yes ___ No ___
What is your preferred pace? Slow__ Fast__ Very fast__ Rigorous___ Rough __
Fantasy, Imagination, and Innovation Section
Instructions for this Section, Fill in the Blank.
List your Four Favorite Positions:
1. ________________________________________
2. ________________________________________
3.________________________________________
4._________________________________________
Any special talent or skills None __ Yes __ If so, list: ________________________________
What could you do for me that no one else could?: _______________________________
Most interesting place you've done it: _________________________________________
Where would you like to do it but have not?(Body) _______________________________
What place would you like to do it but have not? _________________________________
What would you do to me if we were stuck alone together in an elevator for an hour by our
selves?: ___________________________________________________________________
What tickles your fancy? ______________________________________________________
When you are having sex what do you enjoy the best? ________________________________
What’s your specialty? ______________________________________________________
What’s your fantasy? ________________________________________________________
Are you a big freak or nymphomaniac? No __ Yes __ Explain _________________________
Would you like to try more things with your partner? No __Yes __
Do you feel like trying right now? ______________________________________________
Anything else you want me to know? __________________________________________
Are you willing to sign a waiver that frees your partner (me) from all liabilities for any damages or
injuries including but not limited to death, birth, diseases as a result of our sexual liaisons?
Yes __ No__
Sign and Date Here Name _______________ Date ___________
Purpose: To screen potential sexual partners.
Directions: Please read though the questions carefully before answering them. Answer all
questions honestly and to the best of your knowledge.
General Information Section
Last Name: ___________________ First Name _____________ Nick Name _______________
Gender Male __ Female __ Age: ____________ Height Feet ___ Inches___ Weight______ lbs.
Breast Cup Size ____ Waist ______ Hips ______
Endowment: Extra Small __ Small __ Medium __ Large __ Extra Large __ Enormous __
Phone: (____) ____________ e-Mail: ___________________________@ ________._____
Highest Educational Level: 8th Grade or Less __ High School or less___ High School Grad ___
Some College ___ College Degree __ Masters Degree ___ Post Grad ____ Professional __
Occupation: ____________________
Married ____ Single ___ Divorced ___ Separated ___Other____ In A Relationship_____
Sexual Orientation:
Straight ___ Gay ____ Lesbian ___ Bi- Sexual ____ Tri- Sexual (Try Anything) ___
Are you into Sadomaochism(BDSM)? No __ Ye s __ Which One? Sadism ___ Masochism ____
Place a “X” in the correct answer space and write in the answer if applicable.
If more than one answer applies, Check All that Apply
Have you been arrested or convicted of any sex crimes? No __ Yes ___ (If yes, stop here turn in
application)
Do you have any history of serious mental illness? (If yes stop here turn in application)
Did you ever have a sex change operation? No __ Yes __ (If yes stop here turn in application)
Have you ever been alien a*****ed and anally probed? No __ Yes __ ( If yes stop here turn in
application)
Do you like having sex with minor k**s? No ___ Yes __ ( If yes stop here turn in application
Do you have any sexually transmitted diseases? Yes ( If yes stop here, return appl. ) ___ No ___
What age did you start having sex with someone other than yourself? ____
When was the last time you had sex? Today ___Yesterday ___ Last Week ___ Last Month ___
More than a month ago ___ More than a year ago ___
Do you use birth control? No __ Yes __ What Type ___________
Do you use condoms? Yes __ No __
Ever have any STD’s? No ___ Yes ____ Which Diseases? 1. ______________ 2. ____________
How many sexual partners have you had? 0 __ 1 __ 3 to5 ___ 6 to 10 ___ 10 to 15 ___ 15 to 20
___ 25 to 35 ___ 36 or more __ More than you can remember ____
Are you a premature ejaculator? Yes __ No __
Have you ever been stuck together? Yes ___ No ____
Do you sweat when having sex? Yes ___ No ___
What type of nipples do you have? Pointy ___ Short ___ Stubby ___ Inverted ___
What type of pubic hair do you have? Shaved ___ Bush ___ Weave ___ Mohawk ___________
Any Tattoos? Yes _____ Where ________ No _____ Want any? Yes __ No __
Any Piercings? Yes ___ No ___ Want any? Yes ____ Where ____________
Any Brandings? Yes ___ No ___ Want any? Yes ____ Where ____________
Do you like Giving Oral Sex ? No __ Yes __ Receiving Oral Sex? Yes – No ___
Do you Swallow? Yes __ No __ Sometimes __Are you a spitter? Yes ___ No ___ Sometimes __
Do you do Anal? Yes __ No __ Special Occassions __
Do you spank or like to be spanked? Yes ___ No ___ OPM (Other People’s Monkey)__
Do you spank your monkey or choke your chicken? Yes __ No __
Do you like to shower before sex? Yes ___ No (It removes the flavors) ___
Do you like to be tied up? Blind folded? ____ Bitten? ____ Toys? ____
Do you like the lights on or off? On __ Off ___
Do you like clothes on ____ Partially on ____ Butt Naked ____
Do you like to involve food in your sessions? Yes ___ No ___
Do you have any sexual photos or video of yourself? No __ Yes __ Want to make some ___
Which do you prefer? One on one__ Doubles__ Triples __ More than 3 People __ Group___
While having sex, what do you do? Faint__ Cry__ Moan__ Wiggle__ Twist__ Jerk about__ Jerk Off
__ Pant__ Sweat___ Scream__ Squirt ___ Hum__ Whistle__ Just lie there__
How do you like your sexual action? Oral ___ Anal ___ Intercourse ___ Oral only ___ Intercourse
Only ___ All of the Above ___ All the above minus Anal ___
When you are about to cum do you? : Kick and bite.__ Scratch and Scream.__ Kiss and Lick.__ Push
back with increasing determination__ Fart __
When you are having sex do you? Scream.__ Moan __ .Fart __ Bite and scratch ___
How do you prefer your partner? Small.__ Medium.__ Large __ Skinny.__ Wet.__ Thick __ Tight
Long __ Stubby __ Pencil Dick ___
Availability, Frequency, Duration, and Tendencies Section
How often do you want to have sex ? Daily__ Weekly__ Monthly__ As much as possible__
How long can you last? 1min ___ 15min__ 30min__ 1hr__ all night___
Do you prefer Evenings _____ Mornings ____ Nooners (Lunch time) _____
When are you available? 8-12am__ 1-5pm__ 6-10 pm __ all night __ Midnight – 8 am __
Do you like to have sex: Outdoors _____ Indoors ____ In the Shower ___ In a Car _____
Do you talk during sex? Yes __ No __ Can’t talk because your mouth is full __ Can Talk
(Ventriloquist) ____
Do you like to talk dirty? Yes __ No__ Sometimes__ Always__
Skills and Talent Inventory Assessment Section
Do you like to role play? Yes __ No __
Do you like the movie “Deliverance”? Yes __ No ____
Can you squeal like a pig? Yes __ No __
What’s your favorite body parts in order? ( 1 being best 5 being last)
Butt __ breast ___ Chest ___ Mouth ___ Penis ___ Vagina ___ Ears ___ Eyes __
What’s your favorite hole? 1. _____________ 2. ____________ 3. ______________
Have you ever had sex with an a****l live or other wise? Yes __ No __
Do you like to kiss? Yes __ No ___ (If no stop here)
Are you tight or loose? Tight ___ Loose ___ Uptight ___ Other ___________
Did it ever go in the wrong hole? No ___ Yes ____ Explain __________________________
Any weird sexual fetishes? ATM ___ Fisting ___ Golden Showers ___ Brown Showers ___ Baby
Diapers __ Other 1_____________ Other 2 _________________ Other 3 _________________
Do you like inter-racial sex? No __ Yes ___ Preference 1 ___ ___ Preference 2 ____________
Do you like sex with clowns? No _____ Yes _____ Never tried but would like to ____
Do you like sex with midgets? No _____ Yes _____ Never tried but would like to ____
Do you like sex with amputees? No _____ Yes _____ Never tried but would like to ____
Do you like sex with handicapped? No _____ Yes _____ Never tried but would like to ____
Are you handicapped? No__ Yes __ Explain ________________________________________
Do you have big hands and feet? No __ Yes __ If yes explain __________________________
Can you hold a “Q-Tip” in your coochie __ booty __ None __
Do you like sexy lingerie? Yes ___ No ___
What is your preferred pace? Slow__ Fast__ Very fast__ Rigorous___ Rough __
Fantasy, Imagination, and Innovation Section
Instructions for this Section, Fill in the Blank.
List your Four Favorite Positions:
1. ________________________________________
2. ________________________________________
3.________________________________________
4._________________________________________
Any special talent or skills None __ Yes __ If so, list: ________________________________
What could you do for me that no one else could?: _______________________________
Most interesting place you've done it: _________________________________________
Where would you like to do it but have not?(Body) _______________________________
What place would you like to do it but have not? _________________________________
What would you do to me if we were stuck alone together in an elevator for an hour by our
selves?: ___________________________________________________________________
What tickles your fancy? ______________________________________________________
When you are having sex what do you enjoy the best? ________________________________
What’s your specialty? ______________________________________________________
What’s your fantasy? ________________________________________________________
Are you a big freak or nymphomaniac? No __ Yes __ Explain _________________________
Would you like to try more things with your partner? No __Yes __
Do you feel like trying right now? ______________________________________________
Anything else you want me to know? __________________________________________
Are you willing to sign a waiver that frees your partner (me) from all liabilities for any damages or
injuries including but not limited to death, birth, diseases as a result of our sexual liaisons?
Yes __ No__
Sign and Date Here Name _______________ Date ___________
il y a 12 ans
Last Name: ___R_M_______________ First Name ____SAROSH_________ Nick Name _______________
Gender Male _x_ Female __ Age: __27__________ Height Feet 5___ Inches__10_ Weight__665____ lbs.
Breast Cup Size ____ Waist ______ Hips ______
Endowment: Extra Small __ Small __ Medium _x_ Large __ Extra Large __ Enormous __
Phone: (_0091___) 9037931269____________ e-Mail: _____saroshrm______________________@ __Hotmail______._com____
Highest Educational Level: 8th Grade or Less __ High School or less___ High School Grad x___
Some College ___ College Degree __ Masters Degree ___ Post Grad ____ Professional _x_
Occupation: __INTERIOR DESIGNER__________________
Married ____ Single _x__ Divorced ___ Separated ___Other____ In A Relationship_____
Sexual Orientation:
Straight _x__ Gay ____ Lesbian ___ Bi- Sexual ____ Tri- Sexual (Try Anything) ___
Are you into Sadomaochism(BDSM)? No __ Yes __ Which One? Sadism ___ Masochism ____
Place a “X” in the correct answer space and write in the answer if applicable.
If more than one answer applies, Check All that Apply
Have you been arrested or convicted of any sex crimes? No x Yes ___ (If yes, stop here turn in
application)
Do you have any history of serious mental illness? (If yes stop here turn in application)
Did you ever have a sex change operation? No _x_ Yes __ (If yes stop here turn in application)
Have you ever been alien a*****ed and anally probed? No _x_ Yes __ ( If yes stop here turn in
application)
Do you like having sex with minor k**s? No ___ Yes _x_ ( If yes stop here turn in application
Do you have any sexually transmitted diseases? Yes ( If yes stop here, return appl. ) ___ No _x__
What age did you start having sex with someone other than yourself? _22___
When was the last time you had sex? Today _x__Yesterday ___ Last Week ___ Last Month ___
More than a month ago ___ More than a year ago ___
Do you use birth control? No _x_ Yes __ What Type ___________
Do you use condoms? Yes _x_ No __
Ever have any STD’s? No _x__ Yes ____ Which Diseases? 1. ______________ 2. ____________
How many sexual partners have you had? 0 __ 1 _x_ 3 to5 ___ 6 to 10 ___ 10 to 15 ___ 15 to 20
___ 25 to 35 ___ 36 or more __ More than you can remember ____
Are you a premature ejaculator? Yes __ No _x_
Have you ever been stuck together? Yes ___ No __x__
Do you sweat when having sex? Yes _x__ No ___
What type of nipples do you have? Pointy ___ Short ___ Stubby ___ Inverted ___
What type of pubic hair do you have? Shaved __x_ Bush ___ Weave ___ Mohawk ___________
Any Tattoos? Yes _____ Where ________ No _x____ Want any? Yes x__ No __
Any Piercings? Yes ___ No _x__ Want any? Yes _x___ Where ____________
Any Brandings? Yes ___ No _x__ Want any? Yes _x___ Where ____________
Do you like Giving Oral Sex ? No __ Yes _x_ Receiving Oral Sex? Yes –x No ___
Do you Swallow? Yes _x_ No __ Sometimes __Are you a spitter? Yes ___ No _x__ Sometimes __
Do you do Anal? Yes _x_ No __ Special Occassions __
Do you spank or like to be spanked? Yes ___ No __x_ OPM (Other People’s Monkey)__
Do you spank your monkey or choke your chicken? Yes __ No __
Do you like to shower before sex? Yes __x_ No (It removes the flavors) ___
Do you like to be tied up? Blind folded? ____ Bitten? ____ Toys? ____
Do you like the lights on or off? On _x_ Off ___
Do you like clothes on __x__ Partially on ____ Butt Naked ____
Do you like to involve food in your sessions? Yes __x_ No ___
Do you have any sexual photos or video of yourself? No __ Yes __ Want to make some _x__
Which do you prefer? One on one_x_ Doubles_x_ Triples __ More than 3 People _x_ Group_x__
While having sex, what do you do? Faint__ Cry__ Moan__ Wiggle__ Twist__ Jerk about__ Jerk Off
__ Pant__ Sweat___ Scream__ Squirt ___ Hum__ Whistle__ Just lie there__
How do you like your sexual action? Oral ___ Anal ___ Intercourse ___ Oral only ___ Intercourse
Only ___ All of the Above _x__ All the above minus Anal ___
When you are about to cum do you? : Kick and bite.__ Scratch and Scream.__ Kiss and Lick._x_ Push
back with increasing determination__ Fart __
When you are having sex do you? Scream.__ Moan __ .Fart __ Bite and scratch ___
How do you prefer your partner? Small.__ Medium.__ Large __ Skinny.__ Wet.__ Thick _x_ Tight
Long __ Stubby __ Pencil Dick ___
Availability, Frequency, Duration, and Tendencies Section
How often do you want to have sex ? Daily__ Weekly__ Monthly__ As much as possible_x_
How long can you last? 1min ___ 15min__ 30min__ 1hr__ all night_x__
Do you prefer Evenings _x____ Mornings ___x_ Nooners (Lunch time) ___x__
When are you available? 8-12am__ 1-5pm__ 6-10 pm _x_ all night _x_ Midnight – 8 am __
Do you like to have sex: Outdoors __x___ Indoors __x__ In the Shower __x_ In a Car _x____
Do you talk during sex? Yes _x_ No __ Can’t talk because your mouth is full __ Can Talk
(Ventriloquist) ____
Do you like to talk dirty? Yes x__ No__ Sometimes__ Always__
Skills and Talent Inventory Assessment Section
Do you like to role play? Yes _x_ No __
Do you like the movie “Deliverance”? Yes _x_ No ____
Can you squeal like a pig? Yes __ No __
What’s your favorite body parts in order? ( 1 being best 5 being last)
Butt __ breast ___ Chest ___ Mouth ___ Penis _x__ Vagina ___ Ears ___ Eyes __
What’s your favorite hole? 1. _______tight Pussy______ 2. ___vagina_______ 3. ______________
Have you ever had sex with an a****l live or other wise? Yes x__ No __
Do you like to kiss? Yes _x_ No ___ (If no stop here)
Are you tight or loose? Tight ___ Loose ___ Uptight ___ Other ___________
Did it ever go in the wrong hole? No ___ Yes _x___ Explain __________________________
Any weird sexual fetishes? ATM ___ Fisting ___ Golden Showers _x__ Brown Showers ___ Baby
Diapers __ Other 1_____________ Other 2 _________________ Other 3 _________________
Do you like inter-racial sex? No __ Yes _x__ Preference 1 ___ ___ Preference 2 ____________
Do you like sex with clowns? No _____ Yes ___x__ Never tried but would like to ____
Do you like sex with midgets? No _____ Yes __x___ Never tried but would like to ____
Do you like sex with amputees? No _____ Yes _____ Never tried but would like to ____
Do you like sex with handicapped? No _____ Yes _____ Never tried but would like to _x___
Are you handicapped? No_x_ Yes __ Explain ________________________________________
Do you have big hands and feet? No _x_ Yes __ If yes explain __________________________
Can you hold a “Q-Tip” in your coochie __ booty __ None __
Do you like sexy lingerie? Yes ___ No ___
What is your preferred pace? Slow__ Fast__ Very fast__ Rigorous___ Rough x__
Fantasy, Imagination, and Innovation Section
Instructions for this Section, Fill in the Blank.
List your Four Favorite Positions:
1. _69_______________________________________
2. ___doggie_____________________________________
3.______all types__________________________________
4._______________________all types__________________
Any special talent or skills None __ Yes __ If so, list: ________________________________
What could you do for me that no one else could?: _____i can make it attractive__________________________
Most interesting place you've done it: ______anywhere___________________________________
Where would you like to do it but have not?(Body) _______________________________
What place would you like to do it but have not? ___________car,______________________
What would you do to me if we were stuck alone together in an elevator for an hour by our
selves?: _____________seduce and fuck______________________________________________________
What tickles your fancy? ______________________________________________________
When you are having sex what do you enjoy the best? ______when i feels .i like to make her scream loud__________________________
What’s your specialty? ______________________________________________________
What’s your fantasy? ______pinch nipples,lick pussy __________________________________________________
Are you a big freak or nymphomaniac? No __ Yes x__ Explain _________________________
Would you like to try more things with your partner? No __Yes x__
Do you feel like trying right now? ________yes______________________________________
Anything else you want me to know? __________________________________________
Are you willing to sign a waiver that frees your partner (me) from all liabilities for any damages or
injuries including but not limited to death, birth, diseases as a result of our sexual liaisons?
Yes _x_ No__
Sign and Date Here Name _sarosh.R.M______________ Date ____22/01/2015_______
Last Name: ___________________ First Name _____________ Nick Name ____joselito___________
Gender Male _x_ Female __ Age: ___50_________ Height Feet __5_ Inches__6_ Weight___120___ lbs.
Breast Cup Size ____ Waist ______ Hips ______
Endowment: Extra Small __ Small _x_ Medium __ Large __ Extra Large __ Enormous __
Phone: (____) ____________ e-Mail: _________________joselito572003__________@ __yahoo.com______._____
Highest Educational Level: 8th Grade or Less __ High School or less___ High School Grad ___
Some College ___ College Degree __ Masters Degree __x_ Post Grad ____ Professional __
Occupation: _no occupation___________________
Married ____ Single ___ Divorced ___ Separated ___Other____ In A Relationship____x_
Sexual Orientation:
Straight ___ Gay __x__ Lesbian ___ Bi- Sexual ____ Tri- Sexual (Try Anything) ___
Are you into Sadomaochism(BDSM)? No __ Ye s __x Which One? Sadism ___ Masochism __x__
Place a “X” in the correct answer space and write in the answer if applicable.
If more than one answer applies, Check All that Apply
Have you been arrested or convicted of any sex crimes? No __x Yes ___ (If yes, stop here turn in
application)
Do you have any history of serious mental illness? (If yes stop here turn in application) no
Did you ever have a sex change operation? No _x_ Yes __ (If yes stop here turn in application)
Have you ever been alien a*****ed and anally probed? No _x_ Yes __ ( If yes stop here turn in
application)
Do you like having sex with minor k**s? No __x_ Yes __ ( If yes stop here turn in application
Do you have any sexually transmitted diseases? Yes ( If yes stop here, return appl. ) ___ No __x_
What age did you start having sex with someone other than yourself? _11_
When was the last time you had sex? Today ___Yesterday _x__ Last Week ___ Last Month ___
More than a month ago ___ More than a year ago ___
Do you use birth control? No x__ Yes __ What Type ___________
Do you use condoms? Yes __ No x
Ever have any STD’s? No __x_ Yes ____ Which Diseases? 1. ______________ 2. ____________
How many sexual partners have you had? 0 __ 1 __ 3 to5 ___ 6 to 10 ___ 10 to 15 ___ 15 to 20
___ 25 to 35 ___ 36 or more __ More than you can remember __x__
Are you a premature ejaculator? Yes __ No __ x
Have you ever been stuck together? Yes x No ____
Do you sweat when having sex? Yes _x__ No ___
What type of nipples do you have? Pointy __x_ Short ___ Stubby ___ Inverted ___
What type of pubic hair do you have? Shaved __x_ Bush ___ Weave ___ Mohawk ___________
Any Tattoos? Yes _____ Where ________ No ___x__ Want any? Yes _x_ No __
Any Piercings? Yes ___ No __x_ Want any? Yes __x__ Where ___nipples_________
Any Brandings? Yes ___ No _x__ Want any? Yes _x___ Where ___ass_________
Do you like Giving Oral Sex ? No __ Yes _x_ Receiving Oral Sex? Yes – No _x__
Do you Swallow? Yes _x_ No __ Sometimes __Are you a spitter? Yes ___ No __x_ Sometimes __
Do you do Anal? Yes _x_ No __ Special Occassions __
Do you spank or like to be spanked? Yes _x__ No ___ OPM (Other People’s Monkey)__
Do you spank your monkey or choke your chicken? Yes __ No _x_
Do you like to shower before sex? Yes _x__ No (It removes the flavors) ___
Do you like to be tied up? Blind folded? _x___ Bitten? ___x_ Toys? __x__
Do you like the lights on or off? On _x_ Off ___
Do you like clothes on ____ Partially on ____ Butt Naked __x__
Do you like to involve food in your sessions? Yes ___ No x___
Do you have any sexual photos or video of yourself? No __x Yes __ Want to make some _x__
Which do you prefer? One on one_x_ Doubles_x_ Triples _x_ More than 3 People x__ Group__x_
While having sex, what do you do? Faint__ Cry__ Moan_x_ Wiggle__ Twist__ Jerk about__ Jerk Off
__ Pant__ Sweat___ Scream__ Squirt ___ Hum__ Whistle__ Just lie there__
How do you like your sexual action? Oral ___ Anal ___ Intercourse ___ Oral only ___ Intercourse
Only ___ All of the Above __x_ All the above minus Anal ___
When you are about to cum do you? : Kick and bite.__ Scratch and Scream.__ Kiss and Lick._x_ Push
back with increasing determination__ Fart __
When you are having sex do you? Scream.__ Moan _x_ .Fart __ Bite and scratch ___
How do you prefer your partner? Small.__ Medium.__ Large _x_ Skinny.__ Wet.__ Thick _x_ Tight
Long __ Stubby __ Pencil Dick ___
Availability, Frequency, Duration, and Tendencies Section
How often do you want to have sex ? Daily__ Weekly__ Monthly__ As much as possible__x
How long can you last? 1min ___ 15min__ 30min__ 1hr__ all night_x__
Do you prefer Evenings _____ Mornings __x__ Nooners (Lunch time) _____
When are you available? 8-12am_x_ 1-5pm__ 6-10 pm __ all night _x_ Midnight – 8 am __
Do you like to have sex: Outdoors _____ Indoors __x__ In the Shower ___ In a Car _____
Do you talk during sex? Yes __ No _x_ Can’t talk because your mouth is full _x_ Can Talk
(Ventriloquist) ____
Do you like to talk dirty? Yes __ No__ Sometimes_x_ Always__
Skills and Talent Inventory Assessment Section
Do you like to role play? Yes _x_ No __
Do you like the movie “Deliverance”? Yes _x_ No ____
Can you squeal like a pig? Yes _x_ No __
What’s your favorite body parts in order? ( 1 being best 5 being last)
Butt _5_ breast _1__ Chest __1_ Mouth _1__ Penis _1__ Vagina _5__ Ears __3_ Eyes __3
What’s your favorite hole? 1. _mine____________ 2. __mine__________ 3. ____mine__________
Have you ever had sex with an a****l live or other wise? Yes _x_ No __
Do you like to kiss? Yes x__ No ___ (If no stop here)
Are you tight or loose? Tight __x_ Loose ___ Uptight ___ Other ___________
Did it ever go in the wrong hole? No _x__ Yes ____ Explain __________________________
Any weird sexual fetishes? ATM ___ Fisting _x__ Golden Showers _x__ Brown Showers ___ Baby
Diapers __ Other 1_____________ Other 2 _________________ Other 3 _________________
Do you like inter-racial sex? No __ Yes _x__ Preference 1 __any_ ___ Preference 2 __any__________
Do you like sex with clowns? No _____ Yes _____ Never tried but would like to __x__
Do you like sex with midgets? No _____ Yes _____ Never tried but would like to __x__
Do you like sex with amputees? No _____ Yes _____ Never tried but would like to __x__
Do you like sex with handicapped? No _____ Yes _____ Never tried but would like to _x___
Are you handicapped? No_x_ Yes __ Explain ________________________________________
Do you have big hands and feet? No _x_ Yes __ If yes explain __________________________
Can you hold a “Q-Tip” in your coochie __ booty __ None __
Do you like sexy lingerie? Yes _x__ No ___
What is your preferred pace? Slow__ Fast__ Very fast__ Rigorous___ Rough _x_
Fantasy, Imagination, and Innovation Section
Instructions for this Section, Fill in the Blank.
List your Four Favorite Positions:
1. __on my belly______________________________________
2. ___on my back_____________________________________
3.___on my knees_____________________________________
4._____anyone____________________________________
Any special talent or skills None x__ Yes __ If so, list: ________________________________
What could you do for me that no one else could?: ___be your slave____________________________
Most interesting place you've done it: __on a train_______________________________________
Where would you like to do it but have not?(Body) ___public____________________________
What place would you like to do it but have not? _____on water____________________________
What would you do to me if we were stuck alone together in an elevator for an hour by our
selves?: _____suck you and drink your pee______________________________________________________________
What tickles your fancy? __don't understand____________________________________________________
When you are having sex what do you enjoy the best? ___the taste of cum_____________________________
What’s your specialty? _____taking up the ass_________________________________________________
What’s your fantasy? _to be abused by a large group of men_______________________________________________________
Are you a big freak or nymphomaniac? No __ Yes _x_ Explain ___I never say no to a man______________________
Would you like to try more things with your partner? No __Yes _x_
Do you feel like trying right now? _____YESSSSSSS!!!!!
_________________________________________
Anything else you want me to know? __I love to drink pee________________________________________
Are you willing to sign a waiver that frees your partner (me) from all liabilities for any damages or
injuries including but not limited to death, birth, diseases as a result of our sexual liaisons?
Yes _x_ No__
Sign and Date Here Name ____joselito___________ Date __March, 31 st 2014_________