Nova Scotia IPTA Form 3: Psychiatric Assessment Part 2

A physician who has signed a Form 2 uses this short Involuntary Psychiatric Treatment Act certificate when a second physician cannot readily examine the person. By confirming that compelling circumstances exist, the physician makes their single certificate sufficient authority for custody, a 72-hour hold and an involuntary psychiatric assessment, instead of waiting for a second Form 2 from another physician.

Who completes it

The same physician who signed the attached Form 2 completes and signs Form 3, recording the date and time of signature. No other person completes any part of it.

Submitting and payment

How to submit it
Form 3 is attached to the physician's Form 2 and filed with the designated Nova Scotia Health or IWK mental health and addictions staff or administrative office that manages IPTA health records.

Good to know

  • Form 3 is valid only together with a Form 2 signed by the same physician; on its own it gives no authority to take a person into custody or detain them.
  • The physician certifies two things: compelling circumstances exist for the involuntary psychiatric assessment, and a second physician is not readily available to examine the person and complete a second Form 2.
  • When Form 3 is used and there is no second Form 2, the 72-hour hold starts when the first Form 2 was signed, or when the person is detained if they were not present.
  • Subsection 10(2) of the Act is the authority for this route, and the Form 2 instructions confirm a second Form 2 is not needed once Form 3 is completed.

Get the official form

Download the current version from the source each time; forms change without notice.

Form 3 - Certificate for Involuntary Psychiatric Assessment - Part 2

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

When can a physician use Nova Scotia Form 3?

Subsection 10(2) of the Involuntary Psychiatric Treatment Act lets one physician's certificate be sufficient authority when the physician determines compelling circumstances exist and a second physician is not readily available to examine the person and execute a second certificate. Form 3 documents that determination.

Does Form 3 replace Form 2?

No. It must be accompanied by a Form 2 signed by the same physician, which records the examination, the criteria and the reasons. Form 3 only stands in for the second Form 2 that another physician would otherwise complete.

When does the 72-hour hold begin with a Form 3?

The Form 2 instructions say that if Form 3 is used and there is no second Form 2, the 72 hours start when the first Form 2 is signed. If the person is not physically present to be detained when Form 3 is issued, the hold starts when the person is detained.