INSANITY CERTIFICATE NO.

Youve 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 patients
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.

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 commercial 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

650901
Vincent Headrick

condition is (Check one):

certificate No.

Temporary

in testimony whereof:

treatable

incurable

certificant is Harmful to (check all that apply):

asylum Director

self

others

Know ye, whereas ______________________________________

Walter Forsythe

of ______________________________________________
Arkham, Massachusetts
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

Certification of Insanity

April
1927
29th day of _____________,
is duly issued this ______
in the year _______.
* check all that apply:

Dementia Prcox
Delusions
Paranoia
psychogenic Fugue
Dysphoric Mania
Dissociative Identity Disorder
involutional melancholia
Post-Traumatic Stress Disorder
Dyssomnia
Neurasthenia
morbid whimsicality
Trichotillomania
Amnesia
Catatonia
Depersonalization disorder

Tillinghasts 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) ....................................................................

form HPLHS IC-08 2007 HPLHS, Inc. All rights reserved.