The family members of patients here at Midnight Raven Mental Institution and Drug Rehabilitation Center think they're leaving their loved ones in the care of the best medical team in the country. Truth is, these patients are in for a hell like no other...


Patient Application

Falling Inside The Black :: Starting Out :: Requesting Center

Go down

Patient Application Empty Patient Application

Post by The Last Night on Fri Jul 08, 2011 3:02 am

[*img]character Image goes here, take out the *'s[*/img]

Patient Full Name:
Date of Birth:
Age:
Classification: (human or mythic, if mythic, specify type)
Face Claim:
Reason for Commitment:

Application Code:

Code:
[center][*img]character Image goes here, take out the *'s[*/img][/center]

[b]Patient Full Name:[/b]
[b]Date of Birth:[/b]
[b]Age:[/b]
[b]Classification:[/b]
[b]Face Claim:[/b]
[b]Reason for Commitment:[/b]

_________________
Patient Application Adminsigme
The Last Night
The Last Night
Administrator
Administrator

Posts : 5
Join date : 2011-07-07

View user profile http://falling-inside.betaboard.net

Back to top Go down

Back to top

- Similar topics

Falling Inside The Black :: Starting Out :: Requesting Center

 
Permissions in this forum:
You cannot reply to topics in this forum