|
Post by Lilith Winchester on Jul 5, 2012 18:47:31 GMT -5
[atrb=border,0,true][atrb=cellpadding,0,true][atrb=valign, top][atrb=cellspacing,0,true][atrb=style, border: 10px solid #f1e3b4; width: 450px; background-color: #f6f7f1;][STYLE=font-family: courier new; font-size: 25px; color: #191919; text-align: center; letter-spacing: 0px;]-----Patient Admittance and Evaluations Form 1A-----[/style][STYLE=float: right; margin: 10px 10px 0px 0px; padding: 2px; border: 1px solid #000000;][/style][STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]Name: Lilith Winchester Age: 24 Gender: Female Ethnicity: Caucasian/White Hometown: Hell, Michigan
"Tell me about yourself." [/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [CHARACTER'S PERSONALITY]
[/style]
[STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"What are some of your strengths?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [PERSONALITY STRENGTHS - QUIRKS.]
[/style]
[STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"Interesting... in light of that, can you share some of your weaknesses?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [PERSONALITY WEAKNESSES - FLAWS, INSECURITIES.]
[/style]
[STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"Tell me something... if I gave you a mirror, what would you see?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [IMAGE OR DETAILED DESCRIPTION]
[/style]
[STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"Do you, or have you ever, been on an exercise regimen?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [PHYSICAL TALENTS]
[/style]
[STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new] [/style][STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"I see... and how about your mental capabilities... what can you tell me about those?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [TELEPATHY OR TELEKINESIS]
[SUB-CAT 1] [SUB-CAT 2]
[/style]
[STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new] [/style][STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"Is there anything personal to you that you hold on to and take care of?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [ITEMS AND ACCESSORIES.]
[/style]
[STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new] [/style][STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"How about people? Anyone important in your life?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [RELATIONSHIPS - FRIENDS, ENEMIES, RIVALS, LOVERS, RELATIVES]
[/style]
[STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new] [/style][STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]"What can you tell me about your past?"[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [CHARACTER'S BACKGROUND - INCLUDE THE DISCOVERY AND DEVELOPMENT OF PSYCHIC ABILITIES]
[/style]
[STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new] [/style][STYLE=color: #191919; font-size: 10px; margin-top: 10px; margin-left: 10px;]Notes[/style][STYLE= margin: 0px 10px 0px 10px; border: 2px solid #191919; padding: 2px; font-family: verdana; height: 125px; overflow: auto; font-size: 10px; text-align: justify; background-color: #ffffff; opacity: 0.8] [ANY ADDITIONAL INFORMATION HERE]
[/style]
[STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new] [/style][STYLE=color: #191919; font-size: 12px; margin-top: 10px; margin-bottom: 10px; text-align: center; font-family: courier new]-Karen N. Adler, Ph.D Parapsychology, Belkane [/style] | [atrb=border,0,true][atrb=cellpadding,0,true][atrb=valign,top][atrb=cellspacing,0,true][atrb=style, width: 40px;][STYLE=background-color: #f1e3b4; font-family: courier new; font-size: 30px; color: #404040; min-height: 150px; padding: 0px; text-align: center; moz-border-radius: 0px 10px 10px 0px; -o-border-radius: 0px 10px 10px 0px; border-radius: 0px 10px 10px 0px; -webkit-border-radius: 0px 10px 10px 0px;]L. W.[/style] |
|
|