Patient Evaluation Form

There are those who returned to the memories. To the darkened fear that looms in their heart, in their minds.

After you've read the General Rules, copy and submit a Patient character creations sheet Here

IMPORTANT MATERIAL

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[center]-----[b][size=5]Patient Admittance and Evaluations Form 1A[/size][/b]-----[/center]

[b]Name:[/b] [NAME]
[b]Age:[/b] [AGE]
[b]Gender:[/b] [GENDER]
[b]Ethnicity:[/b] [RACE]
[b]Hometown:[/b] [PLACE OF ORIGIN]

[b]'Tell me about yourself."[/b]
[CHARACTER'S PERSONALITY]

[b]"What are some of your strengths?"[/b]
[PERSONALITY STRENGTHS - QUIRKS.]

[b]"Interesting... in light of that, can you share some of your weaknesses?"[/b]
[PERSONALITY WEAKNESSES - FLAWS, INSECURITIES.]

[b]"Tell me something... if I gave you a mirror, what would you see?"[/b]
[IMAGE OR DETAILED DESCRIPTION]

[b]"Do you, or have you ever, been on an exercise regimen?"[/b]
[PHYSICAL TALENTS]

[b]"I see... and how about your mental capabilities... what can you tell me about those?"[/b]
[TELEPATHY OR TELEKINESIS][ul]
[SUB-CAT 1]
[SUB-CAT 2]
[/ul]

[b]"Is there anything personal to you that you hold on to and take care of?"[/b]
[ITEMS AND ACCESSORIES.]

[b]"How about people? Anyone important in your life?"[/b]
[RELATIONSHIPS - FRIENDS, ENEMIES, RIVALS, LOVERS, RELATIVES]

[b]"What can you tell me about your past?"[/b]
[CHARACTER'S BACKGROUND - INCLUDE THE DISCOVERY AND DEVELOPMENT OF PSYCHIC ABILITIES]

[b]Notes[/b]
[ANY ADDITIONAL INFORMATION HERE]

[right][i]-Karen N. Adler,
Ph.D Parapsychology, Belkane[/i][/right]

[b]Role Play Sample[/b]
[A BRIEF ROLE PLAY SAMPLE]

[b]Referral[/b]
[HOW DID YOU FIND OUT ABOUT M.o.D?]

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