[PSYCHOLOGY] Flora Shala

[Flora Shala]

I. PATIENT INFORMATION

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• Title: (select one)
  • [] Mr.
  • [] Mrs.
  • [✔] Ms.
  • [] Other
  First Name:
  Flora
  
  Last Name:
  Shala
  
  Gender: (select one)
  • [] Male
  • [✔] Female
  Date of Birth:
  09/03/1992
  
  Address:
  Integrity Hotel - Floor 5, Room 2
  
  ZIP / Postal Code:
  90017
  

II. CONTACT INFORMATION

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• Phone Type: (select one)
  • [✔] Mobile
  • [] Home
  • [] Work
  • [] Other
  Phone Number:
  4-6-4-6
  
  Email:
  ANSWER ((https://forum.gta.world/en/profile/55430-purplehaze/ ))
  

(( Discord: ))
sleepz666


III. APPOINTMENT DETAILS

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• Has the patient been seen at Pillbox Hill Medical Center in the past?
  • [] Yes
  • [✔] No
  Does the patient have a diagnosis?
  • [] Yes
  • [] No
  If so, please describe:
  Bipolar
  
  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 need to see a therapist to cope with a breakup, threats, abandonment, work pressure, and alcohol-related issues.
  
  Is this condition or injury related to work?
  • [] Yes
  • [] No
  Is this condition or injury related to an auto accident?
  • [] Yes
  • [✔] No
  Department:
  • [] Medical
  • [✔] Psychology
  Dates & Times for Appointment: (list your available dates and times in the next 7 days - use more lines if needed and mark with an 'X' your preferred one. Note that we cannot guarantee exact scheduling, but we will do our best to accommodate the patient's wishes.)
  • [] DD/MMM/YYYY - HH:MM
    [] 13/07/2023 - 18:00
    [] 14/07/2023 - 18:00
    []15/07/2023 - 18:00
    []16/07/2023 - 18:00
  Preferred Doctor for Appointment: (check the list of doctors here and pick one based on personal preference. Note that this is optional and if you don't choose one, one will be automatically assigned to you.)
  Any