Post by Madam Rackle on Aug 19, 2009 7:53:18 GMT -5
Insanity is an unfortunate predicament...but we simply cannot allow those suffering from it to blight our society. Thus, Pointewood Asylum is dedicated to providing a secure environment for those deemed clinically, criminally or dangerously insane...
We would ask that a sane relative or guardian please complete the below form if they wish to admit a patient to our asylum. One may rest assured that our matrons will take good care of them...very good care....
Date of Admission (year 1841):
Name (first and last):
Age:
Sex:
Married, Single or Widowed:
Known Family:
Habits of Life:
Religious Persuasion:
Brought by Whom?:
Form of Insanity:
Supposed cause:
Is hereditary?:
Is suicidal?:
Is dangerous to others?:
Is destructive to property?:
State of bodily health?:
Marks of violence, if any:
Facts specified in medical certificate, upon which opinion of insanity founded:
1. Facts indicating insanity observed by medical man:
2. Other facts indicating insanity, communicated to him by others:
We would ask that a sane relative or guardian please complete the below form if they wish to admit a patient to our asylum. One may rest assured that our matrons will take good care of them...very good care....
Date of Admission (year 1841):
Name (first and last):
Age:
Sex:
Married, Single or Widowed:
Known Family:
Habits of Life:
Religious Persuasion:
Brought by Whom?:
Form of Insanity:
Supposed cause:
Is hereditary?:
Is suicidal?:
Is dangerous to others?:
Is destructive to property?:
State of bodily health?:
Marks of violence, if any:
Facts specified in medical certificate, upon which opinion of insanity founded:
1. Facts indicating insanity observed by medical man:
2. Other facts indicating insanity, communicated to him by others: