West Virginia Judiciary

Mental Hygiene Involuntary Commitment

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Mental Hygiene Involuntary Commitment Forms

REVISED Forms are indicated below. Destroy old forms in your  possession and replace with REVISED Forms below.

Mental Hygiene Involuntary Commitment Forms
Description of Form Signatory
Application for Involuntary Custody for Mental Health Examination with Important Information to Applicants [Revised Nov. 2009] Applicant (under oath)
Application for Involuntary Custody for Mental Health Examination of Minor Chief Medical Officer (under oath)
Application for Incarcerated Individual's MentalHealth Examination under WV Code 27-5-2 [Revised Nov. 2009] Chief Administrative Officer of Correctional Facility (under oath)
Motion to Withdraw Application for Involuntary Custody for Mental Health Examination Applicant (under oath)
Certificate of Licensed Examiner [Revised Sept. 2012] Physician/Psychologist/Ct. Approved Licensed Clinical Social Worker/Ct. Approved Advanced Nurse Practitioner/Physician Assistant
Voluntary Treatment Agreement (VTA) Respondent + Counsel for Resp. + MHC/Judge/Magistrate
Motion for Hospitalization Due to Noncompliance with VTA Mental Health Center or Other Movant
Motion for Cancellation or Modification of VTA Conservator/Guardian; Notary
Chief Medical Officer's Application for Final Commitment [REVISED] Chief Medical Officer
Order to Return Escaped Patient to Facility  Chief Medical Officer of Mental Health Facility
Report of Discharge of Patient Chief Medical Officer of Mental Health Facility
Petition for Court Authorization to Perform Examinations for Probable Cause Proceedings for Involuntary Hospitalization [Revised] Licensed In dependent Clinical Social Worker or Advanced Nurse Practitioner with Psychiatric Certification 
Report/Request of Court Authorized Examiner Regarding Licensing Change [Revised] Licensed In dependent Clinical Social Worker or Advanced Nurse Practitioner with Psychiatric Certification