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

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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]

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