Fillable INSANITY CERTIFICATE NO. 1 Youve paid for your (The H.P. Lovecraft Historical Society)

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INSANITY CERTIFICATE NO. 1 Youve paid for your (The H.P. Lovecraft Historical Society)

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This HPLHS Prop Document is for entertainment purposes only. Designed and implemented by Andrew Leman.
©2007 by HPLHS, Inc. All rights reserved. Permission is hereby granted for the user to print copies for his/her
personal use in role-playing games or personal amusement only. No other permission is granted, and any commer-
cial or illegal use of this digital file or the prop you can make from it is ENTIRELY PROHIBITED.
Please do not distribute this file. It is available at www.cthulhulives.org
INSANITY CERTIFICATE NO. 1
You’ve paid for your knowledge of the Cthulhu Mythos with your sanity, and you might as well get the
acknowledgement you deserve. This handsome certificate is suitable for framing, or can go into the patient’s
permanent medical records.
Use Acrobat form fields to enter the name, city and state of residence, date, and certificate
number. If necessary, you can specify pica, phobia, paraphilia and other conditions with form fields.
You can use the signature form field or delete the default entry and sign the certificate by hand.
Print on elegant off-white resume paper.
Check off all appropriate check boxes by hand.
• Dementia Præcox
• Delusions
• Paranoia
• psychogenic Fugue
• Dysphoric Mania
• Dissociative Identity Disorder
• involutional melancholia
• Post-Traumatic Stress Disorder
• Dyssomnia
• Neurasthenia
• morbid whimsicality
• Trichotillomania
• Amnesia
• Catatonia
• Depersonalization disorder
• Tillinghast’s Complaint
• Xenopharmacophilia
• Monomania
• Hallucinations
• visual
• auditory
• pica (
elaborate
)
...................................................................
• Obsessive-Compulsive Disorder
• Panic disorder
• general cacochymy
• Separation Anxiety
• Hysterical Paralysis
• Repetitive Self-Harm Syndrome
• abject denial
• Sleep Terror disorder
• psychasthenia
• intermittent explosive disorder
• Multi-infarct Dementia
• Epistomophobia
• Agateophobia
• Nyctophobia
• Other Phobia (
Specify
)
.................................................
• Megalomania
• Paragraphia
• Paraphilia (
Specify
) .........................................................
• reactive attachment disorder
• Enamorate delirium (chump syndrome)
• phrenitis
• Selective Mutism
• Other (
Specify
)
....................................................................
Cerficaon of Insanity
condition is (Check one):
• Temporary • treatable • incurable
certificant is Harmful to (check all that apply):
• self • others
certificate No.
in testimony whereof:
asylum Director
Know ye, whereas ______________________________________
of ______________________________________________
has been examined by the staff of this institution and found to be sorely afflicted
with the mental condition(s) noted below;
*
now, therefore, this
is duly issued this ______ day of _____________, in the year _______.
* check all that apply:
form HPLHS IC-08 ©2007 HPLHS, Inc. All rights reserved.
Larry Tilley
Dr. Satan
Ruggsville, Texas
28th
July
1955
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INSANITY CERTIFICATE NO. 1 Youve paid for your (The H.P. Lovecraft Historical Society)

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Completed 13 March 2021

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