State if you have suffered from any of the following:
A detached voice YES/NO
Fainting or Migraine YES/NO
Blood Coughing NO
Proper names NO
Compulsion to make up stories YES/NO
Coughing or hoarseness YES/NO
Sciatica, of long duration NO
An unholy din YES/NO
An empire of crime YES
Is any investigation pending?
If so please specify I LOST MY VISION IN A PROVINCIAL STATION AND NOW I OBSERVE IT THROUGH FIELD GLASSES. I AWAIT FURTHER INSTRUCTIONS.
Have you suffered an injury?
If so state when and how THE ABUSE OF POWER HAS LITERALLY COST ME AN ARM AND A LEG. THIS WAS MANY YEARS AGO NOW. WITH MY WRITING HAND I STRIKE AND STRIKE OUT.
Are you at present on any form of treatment or medical advice?
If so please specify GIVE UP. DON’T GIVE UP. GIVE UP. DON’T GIVE UP. I SELF-MEDICATE BY EATING, SHITTING AND SINGING.
Have you had any specialist advice in the last two years? GET BEHIND VELVET DRAPES. STUMBLE SOFTLY FROM WALL TO WALL. MY GASTROENTOROLOGIST PREDICTED A DIRE SWING TO THE RIGHT BUT I THOUGHT HE WAS STILL JOKING.
Have you lost any time through illness or injury in the past three years?
If so, for what and for how long I HAVE LOST EVERYTHING. WHY DO YOU THINK I AM APPLYING FOR THIS JOB? DO YOU THINK IT IS FOR MY HEALTH?
Do you feel in good health? IS ELIMINATIVE MATERIALISM REALLY SUCH A DIFFICULT CONCEPT? LET ME ANSWER THAT, YES. I STRUGGLE TO FOLD DOWN WINDBLOWN MAPS , LET ALONE HUMANITY.
Have any of your relatives suffered from any of the complaints listed above?
If so, please state which and the relationship of the person to you IF BY COMPLAINT YOU MEAN COMPLICATION AND BY COMPLICATION YOU MEAN EXISTING THEN ALL OF THEM. START FROM HERE: ADRENAL HORMONES SUCH AS GLUTOCORTICOIDS INCREASE WITH STRESS AND DEPRIVATION, AND SUPPRESS NEUROGENESIS IN RATS. NOW RUIN THE TOWN HALL.
How much do you smoke per day? THAT IS A GOOD QUESTION.