Official form guide
This is a court order form for seeking approval to perform psycho-surgery or administer electro-convulsive therapy. It would be used when medical professionals need legal authorization to perform these specialized procedures.
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Form Overview
This is a court order form for seeking approval to perform psycho-surgery or administer electro-convulsive therapy. It would be used when medical professionals need legal authorization to perform these specialized procedures.
Plain English
This form helps doctors get permission from the court to perform certain serious medical treatments. Psycho-surgery and electro-convulsive therapy are special procedures that require court approval before they can be carried out.
Submission Date
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Emergency psychiatric intervention
Different procedures require different approvals
✓ Check if the situation is truly an emergency requiring immediate intervention
Standard medical treatment consent
Standard treatments don't require special court approval
✓ Confirm if your procedure requires court approval
Mental health assessment
Different procedures have different requirements
✓ Ensure you're using the correct form for your specific procedure
Submit this form well in advance of when the procedure is scheduled to allow sufficient time for court review and approval.
Field map
Proceedings
3 items
The names of the parties exactly as they appear on the originating document.
The court record number for the case, if one has been assigned.
The court and the office where the document is being filed.
Substance
2 items
What you are asking the court to do, or the information the form requires.
The facts relied on and any documents exhibited with the filing.
Execution
1 items
Signed, sworn or certified as the form requires, with proof of service where needed.
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Fillable formOpen in Editor->This form appears to be the current version for seeking court approval for these specialized medical procedures.
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Confusing this form with general medical consent forms
Not understanding the difference between psycho-surgery and electro-convulsive therapy
Uncertainty about which court has jurisdiction
Misunderstanding the documentation requirements
Confusing emergency procedures with scheduled procedures requiring pre-approval
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