A physician who has personally examined someone within the past seven days uses this Mental Health Act form to apply for that person's psychiatric assessment in Ontario. The physician completes Box A, the serious harm test, or Box B, for people incapable of consenting to treatment who meet the specified criteria, recording their own observations and facts from others. It authorizes apprehension within 7 days and detention in a psychiatric facility for up to 72 hours.
The examining physician completes and signs the whole form, including the date and time of signing. At the psychiatric facility, the attending physician notes when detention begins and must promptly give the person a Form 42.
Download the current version from the source each time; forms change without notice.
Form 1 - Application by Physician for Psychiatric Assessment
Formule 1 - Demande d'évaluation psychiatrique faite par un médecin
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Form 1 authorizes, for 7 days including the date of signature, the apprehension of the named person and their detention in a psychiatric facility for a maximum of 72 hours. The physician must have personally examined the person within the past seven days before signing.
Box A is the serious harm test under section 15(1), combining past or present behaviour with a likely future outcome. Box B, under section 15(1.1), is for people previously treated who improved, are now incapable of consenting to treatment with substitute decision-maker consent, and are likely to deteriorate or cause harm.
Yes. The French version, Formule 1, Demande d'évaluation psychiatrique faite par un médecin, is posted as form 1315-41 in Ontario's Central Forms Repository, alongside the English 6427-41 in PDF and HTML.