RPG Consent Checklist: Hypnotism & Mind Control

This is a supplemental consent checklist that provides greater precision for its particular subject matter and does not cov-
er all bases by itself. It is intended to be used in conjunction with other consent tools.
At this time the built-in colorblind accessibility and print-friendly design does not display properly in Acrobat Reader.
GM Name:______________________________________ Player Name (optional):___________________________
Planned Game Theme:_____________________________________________________________________________
If this game were a movie, its movie rating would be: PG-13 R NC-17 Other:_____________________

Mark the option which best matches your comfort level as a player with each subject matter, story element, or theme.
Green = Completely fine with this.
Blue = I’m fine with this in the game, just not for my character(s).
Yellow = Okay if it is offstage or veiled; more would require discussion ahead of time; or uncertain.
Red = No, hard limit.

Hypnotism & Mind Control

Focus
Veiled........................................................................
Explicit.....................................................................
Gratuitous...............................................................
Entity Performing Hypnotism/Mind Control
NPC..........................................................................
PC.............................................................................
Non-sentient Entity (e.g. plant or computer
program)..................................................................
Subject of Hypnotism/Mind Control
NPC..........................................................................
PC.............................................................................
Self............................................................................
Enthusiasm (In-Character)
Eager........................................................................
Embarrassed but Willing.....................................
Reluctant/Unwilling..............................................
Effects
Disorientation/Confusion....................................
Unconsciousness/Sleep.......................................
Charm/Improve Disposition................................
Fear/Worsen Disposition.....................................
Paralysis/Restraint................................................
Lower Inhibitions..................................................
Raise Inhibitions....................................................
Limit Actions..........................................................
Limit Thoughts.......................................................
Control Actions
Things Subject Would Normally Be
Willing to Do...................................................
Things Subject Would Not Normally Be
Willing to Do...................................................
Control Thoughts
Limited to Thoughts Subject Would
Normally Have................................................
Not Limited to Thoughts Subject Would
Normally Have................................................
Affect Senses, Subtle............................................
Affect Senses, Dramatic.......................................
Alter Memories
Subtle...............................................................
Copyright 2020 Malachite Idol. Permission Granted to Reproduce For Personal Use.
Dramatic..........................................................
Temporary Suppression or Alteration.......
Rewrite.............................................................
Prevent Memory Retention..........................
Alter Thought Processes.....................................
Limit or Confuse Vocabulary
Small Reduction or Change.........................
Dramatic Reduction or Change..................
Prevent Any Speech......................................
Alter Sense of Self
Mannerisms....................................................
Attitudes...........................................................
Self-Image (e.g. as ideas of own position
in society).........................................................
Moral/Ethical Tendencies............................
Gender Identity...............................................
Sexual Orientation.........................................
Sexual Tendencies (e.g. Dom/Sub,
Preferences for Particular Acts).................
Add or Remove Kinks/Fetishes...................
Subconscious Effects (Only Occur when
Inattentive)..............................................................
Automatic Effects (Occur Unless Actively
Resisting).................................................................
Alter Libido.............................................................
Control Certain Autonomic Responses
Inhibit Gag Reflex..........................................
Orgasm Denial................................................
Forced Orgasm...............................................
Restroom Control..........................................
Increase or Inhibit Erogenous Response
(General or Selectively).................................
Post-Hypnotic Effects Notes or Additional Topics
Delayed Primary Effect
Until Certain Time.........................................
Until Certain Circumstances.......................
Remote Controlled by Source of Effect.....
Reactivation
Only by Repetition of Effect.........................
Chronic............................................................. Would you like the GM to follow up with you about any of
Random............................................................ these, and if so, which?
In Response to Specific Circumstances....
Duration of Potential Reactivation
Less than a Day..............................................
Days..................................................................
Weeks...............................................................
Months..............................................................
Years.................................................................
Until Dispelled................................................
Contingency Effect if Primary is Disrupted.....

Duration
Brief (Less than a Day).........................................
Short Term (Days).................................................
Weeks.......................................................................
Months.....................................................................
Years.........................................................................
Until Dispelled.......................................................
Can Be Ended Or Reversed...
At Will...............................................................
By Removing Item.........................................
By Avoiding Particular Situations..............
With Resource Expenditure........................
By Completing Quest, or Actions...............

Ireversible/Permanent..........................................

Recollection Afterwards
Like a Dream..........................................................
Fuzzy Jumble of Memories..................................
Gradually fades to Nothing..................................
As if Experienced Normally................................
Crystal Clear, as if All Freshly Experienced.....
Amnesia, Gradually Returns...............................
Amnesia, No Recollection at All.........................
Amnesia, Substituted With Similar but
Mundane Memories..............................................
Can Only Be Recalled with Related Effects.....
Recollection Triggered by Subsequent
Command or Implanted Response....................

Copyright 2020 Malachite Idol. Permission Granted to Reproduce For Personal Use.