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[personal profile] personaldemon
1. Name Jason Blood
2. Date of Birth Age as best you know it Biologically I am forty. ((Jason is guessing, here))
3. Are you a fully biological human in all respects? No.
4. Blood type if you know it? A
5. How do you feel about being healed by magical or experimental means? Forms of healing that do not incur debts are acceptable. Do not use any sort of 'holy', 'sacred', or 'blessed' magic upon me.
6. Existing medical conditions? I have an infestation.
7. Taking any medications? Daily aspirin and antacids.
8. Allergic to any medications, or other substances? No medical allergies. See page 2.
9. Is there anything else we should know about you in the occasion that we need to render you medical aid? No.
10. Does anything out of the ordinary happen should you fall unconscious, or die? Etrigan has been known to take control of my body if I am severely injured or incapacitated. Etrigan will be released if I am killed, and free until the next new moon, regardless of what chants are said. See Page 2.

[Next Page]

1. I am a... check One:
  (X) Augmented or enhanced human
  () Undead
  () Shapeshifter
  () Other non-human, please clarify

2. Any substances that are toxic or dangerous to your person and should be kept far from you in case of a medical emergency? Prolonged contact with holy water or blessed or sanctified objects of various faiths will have a negative effect on my person. Short exposure is harmless.
3. What is your resting pulse, if applicable? 70.
4. Normal blood pressure, if applicable? 130/80
5. Normal body temperature, if applicable? 101 F
6. How should we render care to you if you are unresponsive? Are human medicines or medical procedures harmful to you? Human medical procedures are fine. I would prefer Remus Lupin as my primary medical caregiver if he is available. If I am unconscious or dying, my body should be placed within a warding circle to ensure Etrigan cannot move freely. Herr Cabal would know how to effect one of these, or Mr. Lupin.
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Yarva Demonicus Etrigan

September 2016

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