Patient Application

FILL THIS APPLICATION OUT IN AN OOC MANNER. This application is for us to check your character and make sure if they are appropriate for this continuity, and we cannot do this if your character is withholding information for whatever reason. It is fine if the staff ICly would not know, and you may denote what would be secret information if you so wish with parentheses. We will confirm with you when your character is accepted.

Please post a new thread on this forum with the title "Patient Application: [CHARACTER NAME HERE]". We will private message you on the forums the results of your application. Deleted applications will be removed and accepted applications will be kept up as examples.

If your character is rejected and you were not given a chance to amend it, please wait a full 24 hours before applying again.

Remember to read the Character Requirements before you apply!

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Name:
Gender:
Species:
Age:
DOB:
Height:
Weight:

Symptoms: (What makes you think that your character needs help?)
Biography: (Anything in your past that may be a factor in whatever mental illness you may have/Tell us about yourself!)
Medical History: (Any health problems we should know about? Allergic reactions?)

Has your character been referred by a court ruling?: (Is coming here their decision?)
If so, Why?:

Has your character been previously diagnosed with any mental or health illnesses?:
If so, what?

Has your character been known to harm them self or others (or both)?:

Anything else? (Questions, comments, concerns, anything you think we need to know about your character IC and/or OOCly):