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NWT Form 2: Certificate of Involuntary Assessment

A health professional who examines someone in the Northwest Territories and believes they meet the Mental Health Act criteria uses this certificate to have them assessed at a designated facility. It authorizes a peace officer to apprehend the person and convey them there within seven days of issue, then up to 72 hours of involuntary care, observation, examination, assessment and treatment at the facility.

Who completes it

The examining health professional completes the whole certificate, recording their profession, the examination date, time and place, the criteria met and the supporting facts. Under the Act this can be a medical practitioner, nurse practitioner, psychologist or registered nurse allowed to practise in the NWT.

Submitting and payment

How to submit it
The form must be filed with the director of the designated facility where the assessment will happen, with copies to the patient and, where applicable, the substitute decision maker, designated person, guardian, agent or relative. It must be issued within 24 hours of completing the examination.

Good to know

  • The person must meet criterion (a), mental disorder, one of (b)(i) likely serious harm or deterioration or (b)(ii) recent serious harm, threats or attempts, and (c) need for involuntary assessment.
  • Page two records whether the person is already at a designated facility or needs apprehension and conveyance, and the date and time the seven-day authority to apprehend expires.
  • On issuing Form 2, the health professional tells the person they are held under the Act and for how long, and Form 1, Notification of Patient Rights, is completed at the earliest opportunity.
  • A peace officer may require Form 10, Summary Statement Respecting Apprehension or Conveyance. At the facility, a different medical practitioner decides within 72 hours whether to issue Form 3.

Get the official form

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

Form 2 - Certificate of Involuntary Assessment

Formule 2 - Certificat d'évaluation non volontaire

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF 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.

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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

Who can issue a Form 2 in the Northwest Territories?

Any health professional as defined in the Mental Health Act: a psychiatrist or other medical practitioner, nurse practitioner, psychologist or registered nurse allowed to practise in the NWT, or others authorized by regulation. The issuer must have personally examined the person and records their profession on the certificate.

How long is Form 2 valid?

Form 2 must be issued within 24 hours of the examination. It then authorizes apprehension and conveyance for up to seven days after issue, and up to 72 hours of involuntary care, observation, examination, assessment and treatment after the person arrives at the designated facility, or after issue if already there.

Is Form 2 available in French?

Yes. The Department of Health and Social Services publishes Formule 2, Certificat d'évaluation non volontaire, as a separate French PDF under the same catalogue number, NWT9053, with the same criteria and time limits as the English certificate.