Psychosis

[Eris Hawthorn]

Code:


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*Name:
*Age:
*Place of Birth:
*Current Residence:
*Problem/Brief Description of Mental Problem:
*Hours Usable for Rehabilitation:
[b]QUESTIONS:[/b]
Does the usage of Legimens harm or offend you in anyway?
Does the usage of Empathy, a way of distorting feelings offend you?
Do you have allergies or any weaknesses to medical tools?
Do you have another Doctor you'd like to see?
Have you had prior problems to your mental issue?
*Other Information Necesarry:
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Please fill out here, if you would like to admit yourself into the psychosis part of St. Mungos. Thank you.

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