Post by Ariel on Sept 5, 2009 16:52:12 GMT -5
Langston Asylum
Patient Application
Please fill out all fields and print clearly.
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FILE INFORMATION
Patient Application
Please fill out all fields and print clearly.
-------
FILE INFORMATION
NAME
[*list][/list]
AGE
[*list][/list]
BIRTH DATE
[*list][/list]
SCHOOLING
RESIDENCE
RECENT PORTRAIT OF YOURSELF
[*img]
[/img][/center][*img]
DOCTOR INFORMATION
EYES
[*list][/list]
HAIR
[*list][/list]
FACIAL DESCRIPTION
[*list][/list]
BODY DESCRIPTION
[*list][/list]
TATTOOS OR PIERCINGS
[*list][/list]
CLOTHING
DIET
PRESCRIBED MEDICINES
[*list][/list]
THERAPIST INFORMATION
FAMILY MEMBERS
[*list][/list]
PETS
[*list][/list]
FRIENDS
[*list][/list]
PERSONALITY
[*list][/list]
HISTORY
[*list][/list]
FAMILY ILLNESSES
You
ALIAS
[*list][/list]
AGE
[*list][/list]
ROLE-PLAYING EXPERIENCE
[*list][/list]
OTHER CHARACTERS ON THIS SITE
[*list][/list]
PLAY BY
[*list][/list]
SAMPLE ROLE-PLAY
[font=EngraversMT][center][size=5]Langston Asylum[/size]
[size=4]Patient Application[/size]
[size=3]Please fill out all fields and print clearly. [/size]
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[size=3][b]FILE INFORMATION[/b][/size][/center]
[size=2][b]NAME[/b][/size]
[*list][/list]
[size=2][b]AGE[/b][/size]
[*list][/list]
[size=2][b]BIRTH DATE[/b][/size]
[*list][/list]
[size=2][b]SCHOOLING[/b][/size]
[ul]Please list all schools attended and level of schooling.[/ul]
[size=2][b]RESIDENCE[/b][/size]
[ul]Please list all residences that you have ever lived.[/ul]
[center][size=3]RECENT PORTRAIT OF YOURSELF [/size]
[*img][/img][/center]
[center][size=3][b]DOCTOR INFORMATION[/b][/size][/center]
[size=2][b]EYES[/b][/size]
[*list][/list]
[size=2][b]HAIR[/b][/size]
[*list][/list]
[size=2][b]FACIAL DESCRIPTION[/b][/size]
[*list][/list]
[size=2][b]BODY DESCRIPTION[/b][/size]
[*list][/list]
[size=2][b]TATTOOS OR PIERCINGS[/b][/size]
[*list][/list]
[size=2][b]CLOTHING[/b][/size]
[ul]Please include sizes as well as preferences. [/ul]
[size=2][b]DIET[/b][/size]
[ul]Please include any food allergies you may have. [/ul]
[size=2][b]PRESCRIBED MEDICINES[/b][/size]
[*list][/list]
[center][size=3][b]THERAPIST INFORMATION[/b][/size][/center]
[size=2][b]FAMILY MEMBERS[/b][/size]
[*list][/list]
[size=2][b]PETS[/b][/size]
[*list][/list]
[size=2][b]FRIENDS[/b][/size]
[*list][/list]
[size=2][b]PERSONALITY[/b][/size]
[*list][/list]
[size=2][b]HISTORY[/b][/size]
[*list][/list]
[size=2][b]FAMILY ILLNESSES[/b][/size]
[ul]Please indicate if any in your family have also been relocated to an asylum.[/ul]
[center][size=3][b]You[/b][/size][/center]
[size=2][b]ALIAS[/b][/size]
[*list][/list]
[size=2][b]AGE[/b][/size]
[*list][/list]
[size=2][b]ROLE-PLAYING EXPERIENCE[/b][/size]
[*list][/list]
[size=2][b]OTHER CHARACTERS ON THIS SITE[/b][/size]
[*list][/list]
[size=2][b]PLAY BY[/b][/size]
[*list][/list]
[size=2][b]SAMPLE ROLE-PLAY[/b][/size]
[ul][quote]This Role-Play must be a [b]Minimum[/b] of 400 words. It must also be about your character. [/quote][/ul][/font]