
MEDICAL BUSINESS LICENSING APPLICATION
i. RECEIPT OF APPLICATION FEE
Please submit a payment of $2,500 to the Los Santos City Government Account (Routing No: 020000029) and provide proof of payment below ((screenshot)):
- i.i Receipt of Payment: ACCESS
I. APPLICANT INFORMATION
- 1.1 Title: Dr.
- 1.2 Full Name: Sade Aliz
1.3 Date of Birth: 01/09/1987
1.4 Phone Number: 7777-8
1.5 Residential Address: 2108 Hangman Drive
1.6 ((GTAW Forum Name)): Illuminated
II. EDUCATION
- 2.1 Name of High School: Liberty City High School
- 2.2 Year of graduation: 2005
- 2.3 Name of College/University (or N/A): ULSA (Undergrad) BS in Psychology, (Non required MS - Psychology), Standford Medical School D.O., Psychiatry, Board Certification hours completed at the LS Mental Health Clinic
- 2.4 Year of graduation (or N/A): BS Psychology 2009, MS, Psychology 2011, D.O., Psychiatry 2015, Board Certified 2017
III. Practice Information
- 2.1 Business Name: VitaNova Psychology
- 2.2 Business Fictitious Name(s): N/A
- 2.3 Business Address: 310 Rockford Hills
- 2.4 Field of Activities: Psychology, Psychiatry, Mental Health and Wellness
- 2.5 Business Summary:
Via psychology and psychiatry care, our licensed professionals will treat those who have PTSD, trauma, anxiety, depression, and other mood disorders. Our goal is to assist with coping and healing. We want to help Los Santos community members in need embrace life and move forward with their purpose.
VitaNova Psychology will focus primarily on enrolled businesses as an additional compensation benefit for employees, and serve by assisting with overflow patients from local hospitals and clinics.
VitaNova Psychology will host regular health and wellness events for the children of Los Santos.
IV. SHAREHOLDERS
- Mark with where applicable.
3.1 Is the applicant in possession of the majority of shares (>50%) of the business?
Yes
No
3.1.1 If selected "No" in the previous question include reasoning (Within the State of San Andreas a Physician must be the 51%+ holder):
N/A
3.2 List of Shareholders
Full Name Date of Birth Phone Number Number of Shares Sade Aliz 01/09/1987 7777-8 100
V. ADDITIONAL INFORMATION
- 4.1 Anything else you would like to add?
N/A
4.2 Any other employee's requiring licensing?
None