forms raze please provide your full name, date of birth, address, and social insurance number. if you share your home with another person, specify whether they're a spouse, a family member, or a figment of your imagination. have you sought psychiatric care for your condition? are you on medication of any kind? here is a space in which you can sketch a self_portrait. here are some boxes waiting to be scarred with the symbol of your choice. here is a litany of lines hardy enough to hold the hell you've been hardened by. don't tell us what you dream about at night or what you know of love. we have no interest in any of that. we only want to know what's broken you. 261107 what's it to you? who go blather from