Forms

A complete set of forms related to the Mental Health Act is provided below:

Form 1 – Application for Order for Involuntary Examination (PDF, 53 KB)
Form 2 – Order to Apprehend (PDF, 53 KB)
Form 3 – Statement of Peace Officer on Apprehension (PDF, 53 KB)
Form 4 – Recommendation for Involuntary Psychiatric Assessment (Physician) (PDF, 67 KB)
Form 5 – Recommendation for Involuntary Psychiatric Assessment (Nurse) (PDF, 53 KB)
Form 6 – Patient’s Right to be Informed (PDF, 41 KB)
Form 7 – Certificate of Involuntary Admission (PDF, 66 KB)
Form 8 – Waiver of Right to an Automatic Hearing (PDF, 55 KB)
Form 9 – Application to the Capability and Consent Board for matters under the Mental Health Act (PDF, 52 KB)
Form 10 – Authorization for Specified Treatment (PDF, 52 KB)
Form 11 – Certificate of Renewal of Involuntary Admission (PDF, 67 KB)
Form 12 – Certificate of Change of Status (PDF, 52 KB)
Form 13 – Notice of Intention to Transfer an Involuntary Patient (Yukon Resident) (PDF, 55 KB)
Form 14 – Review of Proposed Patient Transfer (PDF, 55 KB)
Form 15 – Application for Transfer of a Non-Resident Involuntary Patient (PDF, 40 KB)
Form 16 – Temporary Release of Involuntary Patient (PDF, 38 KB)
Form 17 – Certificate of Return (PDF, 38 KB)
Form 18 – Application to Withhold Clinical Record (PDF, 53 KB)
Form 19 – Request for Correction of the Clinical Record (PDF, 36 KB)
Form 20 – Statement of Disagreement with a Clinical Record (PDF, 36 KB)
Form 21 – Consent to Disclosure, Transmittal or Examination of a Patient Record (PDF, 36 KB)