Consent form

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A consent form is a document sometimes used by pro doms and other BDSM practitioners before undertaking a scene during the process of negotiation as a way to develop an understanding of risk and established informed consent between the participants, this is more frequently common when practicing edge play with strangers. Many of these forms may strike a strong resemblance to a BDSM Checklist.

Such documents are not legally binding and provide no legal protections and in some cases certain activities participated in may be considered illegal according to local laws.

Example Consent Form

  • I (bottom(s), legal name) give consent to engaging in BDSM practices with (top(s), legal name) and I recognize that exposure to potential grievous bodily harm and/or death is considered incidental during these activities.
  • I (top(s), legal name) give consent to engaging in BDSM practices with (bottom(s), legal name) and I recognize that I may exposure the bottom to potential grievous bodily harm and/or death and this is considered incidental during these activities.
  • The top/bottom recognize that my expressed consent to these activities does not protect me from litigation.
  • In case of an emergency the following person will be discreetly contacted: (insert legal name and phone for each participant's emergency contact)
  • I, bottom/top, recognize that failure to report any serious medical conditions is a breach of consent.
  • I, bottom/top, have the following medical/special conditions (check all that apply):
    • Anemic/easily bruised
    • Anxiety
    • Asthma
    • Blood Borne Illnesses
    • Blood Pressure Issues
    • Broken Bones
    • Chronic pain and/or stiffness
    • Common cold/flu
    • Damageable cosmetics
    • Diabetes
    • Extreme sensitivity/tenderness
    • Fibromyalgia
    • Heart Attack History (specify)
    • Heart Condition (specify)
    • Implants (including IUD)
    • Joint problems
    • Married and/or Children
    • Medical device
    • Pace Maker
    • Pregnancy [or risk of]
    • Prosthetic limbs/joints
    • Seizures/Epilepsy
    • Special Discretion Requirements
    • STD/STI (specify)
    • Swelling
    • Urinary/Bowel Issues
    • Former Severe Medical Condition
    • NONE
    • other:
  • The bottom/top has the following allergies and take the following medications of ANY KIND. Include all allergies to food/drugs. Medications that you are currently on, supposed to be on and are not taking, Drug Addiction and/or Recreational Drug Use. Indicate side affects of medications.
  • The bottom/top has the following historical psychological conditions: List all, especially depression, mania, neurosis, psychotic breaks, suicidal attempts, known negative psychological triggers.
  • The bottom prefers positive/negative/indifferent reinforcement from the top.
  • The bottom/top cannot or would not like to experience the following things during a scene (in your own words):
  • The bottom/top would like to experience the following things during the scene (in your own words):
  • The bottom/top would like aftercare administered in the following manner (in your own words):
  • The bottom/top recognizes consent may be withdrawn at any time, without explanation, by either party.
  • The bottom/top recognizes that the top has a responsibility to care for the well being of the bottom to the best of their ability, to include using their best judgement to assess the mental and physical states of the bottom, and whether or not play should continue.
  • The bottom/top recognizes, that the bottom has a risk of entering a state of diminished capacity where they may not be able to articulate the desire to revoke consent and trusts that the top will do their best to interpret body language at all times, and that should a negative experience occur, while both act in good faith to the agreements during such a period of diminished capacity, the bottom will seek resolution through communication about their feelings when they are able, rather than seek retribution or reparations.
  • The bottom/top understands and gives informed consent to the associated risks, has been allowed to ask questions concerning any safety concerns and is prepared to accept the consequences of the agreed upon consensual activities.

Signed, dated and contact phone listed by all participants and a third party when possible.