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NWT Form 3: Certificate of Involuntary Admission

Within 72 hours of a person arriving at a designated facility under Form 2, a medical practitioner assesses them in person and, if all three admission criteria are met, issues this certificate under the Northwest Territories Mental Health Act. It authorizes involuntary admission, detention and treatment for up to 30 days, and conveyance to a different designated facility if needed.

Who completes it

A medical practitioner completes and signs the whole certificate, including facts personally observed, facts from others and a differential diagnosis or diagnosis. It must not be the same medical practitioner who issued the Form 2.

Submitting and payment

How to submit it
The certificate is filed with the director of the designated facility where the patient is admitted, and copies go to the patient and listed others such as a substitute decision maker. The director ensures the Director of Mental Health receives a copy.

Good to know

  • All three criteria are required: mental disorder; likely serious harm, substantial mental or physical deterioration, or serious physical impairment if not admitted; and unsuitability for voluntary admission.
  • The form records the date and time the Form 2 was issued and expires, and the exact date and time this 30-day certificate expires.
  • After admission the form lists follow-ups: Form 1 patient rights, assessment of competence to make treatment decisions (Forms 11 and 12), and competence to manage an estate (Form 14).
  • If conveyance to another facility is delayed, the patient may be held up to 72 hours pending conveyance. Renewal uses Form 4 and cancellation uses Form 5.

Get the official form

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

Form 3 - Certificate of Involuntary Admission

Formule 3 - Certificat d'admission involontaire

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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

How long does a Form 3 involuntary admission last in the NWT?

Form 3 authorizes involuntary admission, care, observation, examination, assessment and treatment for up to 30 days after it is issued. Within 72 hours before it expires, the attending medical practitioner must reassess the patient and either cancel it with Form 5 or renew it with Form 4.

Can the same doctor sign Form 2 and Form 3?

No. Under section 13(2) of the Mental Health Act, as the Department's guide explains, the medical practitioner who assesses the person and issues Form 3 must not be the same medical practitioner who issued Form 2, the Certificate of Involuntary Assessment.

Can a patient challenge Form 3?

Yes. Anyone can apply to the NWT Mental Health Act Review Board to cancel a Certificate of Involuntary Admission and have the patient released from the designated facility. The patient is told of their rights, verbally and in writing, through Form 1 when Form 3 is issued.