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Submittals – Needs Based Assessment

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Submit the below form if you are seeking more information and are a Chicago area lady interested in scheduling an appointment, arranging on-going sessions, or becoming involved in something more serious, for purposes that are either directly or indirectly related to, inadequate and/or inappropriate, singular or reoccurring, behavioral issues that you may need to have corrected.

I am a

In the age range

I am submitting this form in order to

My interests are

Punishment

Discipline

My role is

Dominant

Submissive

Variable

My spank related interests are of the context:

Role-Play

Domestic Discipline

Corporal Punishment

Judicial Punishment

Sensual

Other

I think that an effective spanking should incorporate, address, and/or bring to the surface these feelings:

Embarrassment

Shame

Guilt

Fear

Humiliation

Frustration

Helplessness

Acceptance

Anger

Relief

Pain

Eroticism

I think that an effective spanking, pertinent to my situation, should accomplish:

Enhanced Communication

Behavior Modification (Improvement and/or Maintenance)

Emotional and/or Physical Outlet

Closure to a Situation

Piece of Mind

Therapeutic Objectives

City/Region:

E-mail address (needed for reply):

Comments

Homepage:

http://www.geocities.com/dblejj_60516/templ.htm

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