Complete the Arizona Application for Involuntary Evaluation by following these five steps. Each step ensures the form meets the legal requirements of A.R.S. § 36-520 and reaches the correct reviewing authority.
Step 1: Identify the Proposed Patient
Enter the full name, date of birth, age, sex, race, and current address of the person you believe needs evaluation. Include a physical description if the person's location is unknown to local authorities.
Step 2: Describe the Basis for Evaluation
State clearly why you believe the person has a mental disorder and is a danger to themselves or others, or is gravely disabled. Describe specific incidents, dates, and behaviors you have directly observed. General or vague statements may cause the screening request to be denied.
Step 3: Provide Your Contact Information
Fill in your full name, address, phone number, and your relationship to the proposed patient. The county screening agency may contact you to clarify information before proceeding.
Step 4: Get the Form Notarized
Before submitting, take the completed form to a notary public. The notary must witness your signature and certify the document. The form has no legal standing without notarization. Notary services are available at most county courthouses, banks, and shipping stores.
Step 5: Submit to Your County Authority
Deliver the notarized form to the behavioral health pre-petition screening agency in the proposed patient's county. Contact Arizona DBHS if you are unsure which agency handles your area. For other Arizona legal and health forms, see the Arizona DNR Form, the 388 Petition Form, and the Superbill for Mental Health.