Institutional Confinement Consent Agreement
I, _______________________ (hereinafter "Patient") do hereby waive my rights and freedoms for the purpose of voluntary commission to The Institution to undergo a program of Bondage Therapy. The program period is to begin at ________ PM on ___________.
During the commitment period, the Patient will be incarcerated/restrained at all times using methods deemed appropriate by Institution staff. For no reason will the Patient be allowed out of restraint until the program period is over.
The Institution Staff may at their discretion perform medical experiments on the Patient, which may include the use of insertive anal devices or other manipulative tools, and genital stimulation. Further, in order to complete certain therapies, the Patient will may be required to have direct bodily contact with Institution Staff. In such circumstances strong safety precautions against possible infection will be observed.
At some times, Institution Staff may need to inflict painful stimulations on the Patient to achieve a desired therapeutic result.
Food will be provided to the Patient by the Institution Staff. The Patient has the right to refuse food, however the Patient may not select the variety of food to be served.
Institution Staff may at times authorize other persons not employed by the Institution to supervise the Patient. Such persons will not perform genital or painful stimulation without the prior consent of the Patient, however non-painful stimulation to other parts of the Patient may occur as directed by Institution Staff.
The Patient is expressly forbidden to achieve sexual climax (orgasm) without the permission of the Institution Staff, as the sensation of climax may seriously damage the effects of the therapy. Should the Patient violate this rule, following punishment will be applied.
If during the commitment period it is determined that extended treatment will provide beneficial results, the commitment period may be increased by four hour increments by mutual verbal declarations of consent between the Patient and Institution Staff.
The Patient must follow all orders of the Institution Staff. Patients who refuse to obey orders risk solitary confinement without positive stimulation or manipulation from Institution Staff.
At the end of the commitment period, Institution Staff will present a diagnosis to the Patient and a recommended date when the Patient should return for additional therapy.
I fully understand the terms of this agreement and hereby declare that I will, to the best of my ability, attempt to comply with my responsibilities as outlined herein. Failure to comply, in addition to the disciplinary measures specified, may result in being barred from attending future therapy sessions with the Institution.
Patient Staff Supervisor