I. PATIENT INFORMATION
- Title: (select one)
- [ ] Mr.
- [ ] Mrs.
- [✗] Ms.
- [ ] Other
Chloe
Middle Name: (optional)
Louise
Last Name:
Hill
Gender: (select one)- [ ] Male
- [✗] Female
16/10/1985
Address:
N/a / Homeless
ZIP / Postal Code:
N/a / Homeless
II. CONTACT INFORMATION
- Phone Type: (select one)
- [✗] Mobile
- [ ] Home
- [ ] Work
- [ ] Other
7505
Email:
[email protected] (( World Prop ))
III. APPOINTMENT DETAILS
- Has the patient been seen at Pillbox Hill Medical Center in the past?
- [✗] Yes
- [ ] No
- [✗] Yes
- [ ] No
Schizophrenia / Schizoaffective, Depression
Reason for Appointment: Please let us know why the patient needs this appointment. (i.e. symptoms or part of the body that is affected.)
I will start with an apology to the staff at this hospital, as in the past it seems I caused trouble here. This was a long time ago now, especially for me. I am on a course of medication to help what I'm dealing with, and I am feeling better than who I was. I would like to see someone here, and have a place where I can feel comfortable if need be, and for some people to understand what's going on inside my head, as sometimes I'm even lost on that. I've tried reaching out before, but it hadn't gotten anwhere and I'm trying to make the right steps to becoming a better person, especially since I have children now. I am worried that if I don't seek the right help, things may fall out of my control again, and I really do try my best. I'm looking for someone I can regularly visit and go through my problems with, and get things back on track.
Is this condition or injury related to work?- [ ] Yes
- [✗] No
- [ ] Yes
- [✗] No
- [ ] Medical
- [✗] Psychology
- 27th / Friday: 4pm onwards to 2am approx.
28th / Saturday: not available or available very later on (10pm onwards)
29th / Sunday: availability the same as Friday
30 th / Monday etc. the same onwards as the Friday times
I can probably make myself available for anything, my schedule is rather fluid.
etc. the same onwards.
Someone 'on the level', someone who's not condescending. A person I can be real with, talk to like a friend.