Sanatorium Secrets: Slot Overview
It might be an outdated term now, but the word 'sanatorium' still conjures up uncomfortable feelings; all those locked wards and whisper-thin walls, where treatment is more like punishment and every corridor oozes tortured memories of its patients. At least, these are the thoughts that came to the fore after braving Pragmatic Play's online slot Sanatorium Secrets. In a place where problems are swept into dark corners rather than dealt with until they can be contained no longer and come roaring back for vengeance, steely-nerved players can find a variety of wild symbol action, a pre-feature Puzzle round, plus a host of multiplying and transforming activity besides.
Bearing a name like Sanatorium Secrets means this is not going to be a slot about rainbows and unicorns. And so it is when the game plasters itself on the screen, as players find themselves by gates in the base game, an ominous building in the distance, where the sanatoriuming occurs. It's a misty, grey, dark institution, the sort of place people are released in an even more messed-up state than when they went in, if they come out at all. Justice would appear to be served during free spins as the sanatorium goes up in smoke along with all the nasty, buried secrets contained therein. Hopefully, patients and players manage to claw their way out unharmed physically and psychologically from this sort of Silent Hill 2 meets Outlast style slot.

Sanatorium Secrets' gaming grid is a 6x4 matrix, where there are 4,096 ways to win. Players enter by selecting a stake from $/€0.20 to $/€240, and have an ante bet as well as a couple of feature buys available to them. Powering the machine is a medium volatile math model, and the maximum RTP is 96.47%.
Playing card ranks 9-A crawling in spiders are Sanatorium Secrets' low pays, while four characters make up the premium symbols. Landing 6 matching royals is worth 0.5x to 1.2x the bet, or 1.5x to 10x is awarded when a 6 matching high pay combination lands. Regular 1x1 wilds appear on reels 2-5, via the conversion of a high pay symbol by the Hook . These 1x1 wilds substitute for all symbols except scatters, as do all wild types.
Sanatorium Secrets: Slot Features

The doc's list of features in this sanatorium includes several special symbols, free spins with a pre-bonus Puzzle round, an ante bet, and feature buys.
Special Symbols
The three special symbols covered here are the 1x4 Wild, 2x4 Wild, and Hook.
- 1x4 Wild: Appears on reels 2-5. When it hits, it can randomly have a multiplier of x4 or x8. Wild multipliers apply to all winning combinations passing through them. Multiplier values are added to each other if more than one participates in the same win.
- 2x4 Wild: Appears on reels 3 and 4. This wild can land with a multiplier of x8 to x64.
- Hook: Appears on the leftmost and rightmost reels. When it hits, it grabs all high pay symbols on its row, transforming itself into a matching high pay symbol or clusters of them. It also transforms those high-paying symbols into 1x1 wilds. If the Hook passes over any wilds, it doubles their multipliers.
Free Spins
Scatters appear on reels 2-5, while the super scatter may only hit on the rightmost reel. Landing 3 scatters triggers the free spins feature, while 3 scatters and a super scatter triggers the super free spins feature. Before the round starts, a hold & win style Puzzle feature plays first. Whenever a new puzzle piece lands, it locks in place, resets the spin count, and grants +1 free spin. If a reel is filled with sticky puzzle pieces, the high pay symbol above it turns wild for the free spins round.
In addition, 1 or 2 Hook symbols may land on the leftmost and rightmost reels. Any Hook symbol that lands will appear in the free spins feature in a random position on every spin. If the round was triggered with a super scatter, 2 x Hook symbols are guaranteed to land in the Puzzle feature. A multiplier of +1x can also appear on the two outer reels. Each one increases the minimum multiplier that the 1x4 Wild symbols can hit with during the round. The Puzzle feature ends when there are no more respins left, or puzzle pieces cover reels 2-5. If puzzle pieces do cover the four reels, then the max win is awarded and the feature ends.
The free spins or super free spins round starts with 6 free spins plus an additional 2 for each triggering scatter beyond the third. During the bonus, new wild symbols transformed in the Puzzle round may appear on the middle four reels. Whenever a Hook passes over a high pay symbol transformed into a wild, it transforms it back to a 1x1 wild and doubles its current multiplier.
Ante Bet and Feature Buys
Activating Sanatorium Secrets' ante bet doubles the bet to make the chance of triggering free spins 4 times higher. There are two feature buys, as well. Paying 75x randomly triggers free spins or super free spins, or by paying 150x the bet, the super free spins are guaranteed to trigger.

Sanatorium Secrets: Slot Verdict
Sanatorium Secrets is a release that puts a lot of emphasis on atmosphere, and to be fair, it mostly delivers. The gloomy, institutional setting does a nice job of pulling curious players in, with its misty façade, shadowy interiors, and uneasy sense that something really isn't right here. It might not be the most disturbing horror slot out there; a release such as Mental, for example, scores slightly higher on the shivering down the spine meter, but Sanatorium Secrets possesses enough psychological horror executed with more than enough confidence in order to feel compelling rather than derivative.
Peel off the skin, and Sanatorium Secrets' mechanics shine just as bright. Here, players can find a mix of full reel wilds, multipliers, and Hook transformations. On their own, features are capable of good things, but bringing them together is where the pulse really starts to race. The Hook symbol is a good one, keeping players on their toes, transforming symbols and boosting multipliers in a way that fits the chaotic tone, as is the Puzzle feature. Even before free spins begin, the game is busy building anticipation for some, hopefully, big stacking multipliers.
One question mark lay over whether the volatility and 10,000x win cap are high enough to satisfy gamblers drawn to Sanatorium Secrets' competitors, but is a slot capable of swinging from modest wins to more explosive outcomes should everything align. There were moments when it felt like Sanatorium Secrets could've been something Nolimit City might have released. But that's a compliment rather than a critique, as Sanatorium Secrets is its own beast, possessing a dark, tasty vibe which backs up its eerie atmosphere with tension-filled gameplay.
Sanatorium Secrets combines a strong horror atmosphere with chaotic feature interplay, delivering a tense and engaging slot that backs up its theme with solid gameplay.


